A136 – Repeat consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A repeat consultation is 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 A136 when a patient returns for a follow-up of the same complex issue after seeing another specialist for a different aspect of their care in the interim.
- Use A136 if the patient was managed by their GP for a new acute issue between your initial consultation and the requested repeat consultation for the original problem.
- A136 is appropriate when a new referral is received for the same presenting problem, and the patient has been seen by another physician for that problem since your last assessment.
Common Pitfalls
- Billing A136 without a new, valid referral from a physician, NP, or dental surgeon will result in the claim being adjusted to a lesser assessment fee.
- Claims for A136 are frequently rejected if documentation does not clearly indicate intervening care by another physician for the same presenting problem.
- Do not bill A136 if the patient's subsequent care was managed by you or your group; this code specifically requires care by a *different* physician in the interval.
Billing Tips
- Ensure the report to the referring provider clearly outlines the intervening care by another physician and why your repeat opinion is necessary for the original problem.
- When billing A136, confirm the patient is under 16 to determine eligibility for age-based fee premiums.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Consultation
Requires a new written request from a referring physician, nurse practitioner, or dental surgeon.
Must include all elements of a full consultation: history, physical examination, review of relevant data, and a written report to the referring provider.
The patient must have received care from another physician in the interval between the initial consultation and the repeat consultation for the same problem.
If the requirements for a repeat consultation are not met (e.g., no new referral or no intervening care by another physician), the service will be adjusted to a lesser assessment fee.
Eligible for age-based fee premiums for patients under 16 years of age (10% to 30% increase).
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