A166 – Nephrology 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 A166 when a patient, after seeing another physician for a new issue since their initial nephrology consultation (A165), returns for a follow-up assessment by the same nephrologist for the original presenting problem.
- Use A166 if the patient was managed by another physician (e.g., GP, cardiologist) for a related issue between the initial A165 consultation and the subsequent nephrology assessment, and the nephrologist is re-evaluating the original problem.
- A166 is appropriate when a new referral is received for a patient previously seen for the same nephrology issue, and another physician has intervened in their care since the last consultation.
Common Pitfalls
- Billing A166 without a new, valid referral from a physician, NP, or dental surgeon will result in the claim being reduced to a lesser assessment fee.
- Submitting A166 when the patient has not been seen by another physician in the interval since the initial consultation will lead to rejection, as it does not meet the definition of a repeat consultation.
- Failure to include a detailed written report to the referring provider with findings, opinions, and recommendations can cause the claim to be downgraded or rejected.
Billing Tips
- Ensure the referral clearly states the patient was seen by another physician since the initial consultation and specifies the presenting problem for the repeat assessment.
- Verify that the interval between the initial consultation and the repeat consultation involved care by another physician for the same presenting problem to justify A166 over a standard visit code.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultation
A written request from a referring physician, nurse practitioner, or dental surgeon is required.
The consultant must provide a written report (including 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 signed written request must be kept in the consultant's medical record (unless a common medical record is used in a hospital or multi-specialty clinic).
The request must identify the consultant, the referrer (including billing number), and the patient (including health number).
The service must follow care rendered to the patient by another physician in the interval since the initial consultation.
A repeat consultation has the same requirements as a full consultation, including the need for a new written request.
If the requirements for a consultation are not met (e.g., no written request or report), the fee will be reduced to a lesser assessment fee.
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