A096 – Repeat consultation
OHIP General Listings Code — CARDIAC SURGERY (09) · Schedule of Benefits
An additional consultation rendered by the same consultant, in respect of the same presenting problem, following care rendered to the patient by another physician in the interval following the initial consultation but preceding the repeat consultation.
When to Use
- Bill A096 when a patient returns for a follow-up cardiac surgery consultation for the same presenting problem, and another physician has provided care in the interim since your initial consultation.
- Use A096 if the patient was initially seen by another physician for the same cardiac issue, and you are now performing a repeat consultation after that interval care.
- A096 is appropriate when a new written request for a repeat consultation is received, specifically detailing that another physician has managed the patient's cardiac issue since the initial consultation.
Common Pitfalls
- Billing A096 when the patient has not received care from another physician in the interval; this scenario may require billing a regular consultation (A095) or a follow-up visit code.
- Failure to obtain a new, distinct written request specifically for the repeat consultation can lead to rejection; the original consultation request is insufficient.
- Submitting A096 without ensuring a written report detailing findings and recommendations has been sent to the referring physician can result in claim issues.
Billing Tips
- A096 is not subject to the 'one per 24 months' limit that applies to regular consultations (A095), allowing for more frequent repeat consultations if clinically indicated and properly requested.
- Ensure the repeat consultation is for the 'same presenting problem' as the initial consultation; a new problem would necessitate a new consultation code.
Effective: June 1, 2025
A. Consultations and Visits
CARDIAC SURGERY (09)
Specialist
Consultation
Written request from a referring physician, nurse practitioner, or dental surgeon
New written request required specifically for the repeat consultation
Written report including findings, opinions, and recommendations must be sent to the referrer
Must follow care rendered by another physician in the interval since the initial consultation
A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician’s medical record, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
The request identifies the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
If requirements are not met, the fee is adjusted to a lesser assessment fee.
Physician in hospital but not on duty in the emergency department should use this General Listing (A096).
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