A156 – 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 A156 when a patient returns for follow-up on the same presenting problem after seeing another physician (e.g., their GP) for a different issue in the interim.
- Use A156 if you previously performed an initial consultation (A155) for a specific problem, and the patient was then managed by another physician before returning to you for further consultation on that same problem.
- A156 is appropriate when a new written request is received for a follow-up consultation on the same presenting problem, provided another physician has seen the patient since your last consultation for that problem.
Common Pitfalls
- Billing A156 when the patient has not been seen by another physician in the interval; this scenario requires a different billing code, not a repeat consultation.
- Failure to obtain a new written request from a referring physician, NP, or dental surgeon for the repeat consultation can lead to payment reduction to a lesser assessment fee.
- Submitting A156 when the patient is returning for ongoing management of the same problem without an intervening physician's care; this is not a repeat consultation.
Billing Tips
- Ensure the interim care by another physician is clearly documented in the patient's chart to support the A156 claim.
- When billing A156, confirm that the patient's record contains a new, valid written request that meets all specified requirements, including provider and patient identification.
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.
The consultant must have previously rendered an initial consultation for the same presenting problem.
Another physician must have rendered care to the patient in the interval between the initial consultation and the repeat consultation.
Includes all services necessary to prepare a written report (findings, opinions, and recommendations) to the referring provider.
The consultant must perform a general, specific, or medical specific assessment, including a review of all relevant data.
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.
In the event these requirements are not met, the amount payable for a consultation will be reduced to a lesser assessment fee.
A repeat consultation is an exception to the general rule that limits consultations for the same diagnosis to one per two consecutive 12-month periods.
If the requirements for a repeat consultation (e.g., new written request or interval care by another physician) are not met, the service may be adjusted to a lesser assessment fee.
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