A196 – Repeat psychiatric 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 A196 when a patient returns for follow-up on the same psychiatric issue after seeing another physician (e.g., GP, internist) for a different medical problem in the interim.
- Use A196 if the patient was initially seen by you for a psychiatric consultation (A190) and subsequently managed by another physician for the same presenting problem before returning to you for a repeat assessment.
- A196 is appropriate when the patient's primary care physician or another specialist has managed a related medical condition between your initial psychiatric consultation and the subsequent visit for the same psychiatric concern.
Common Pitfalls
- Billing A196 without a new, valid written request from a referring physician, NP, or dental surgeon will result in the claim being adjusted to a lesser assessment fee.
- Submitting A196 when the patient has not been seen by another physician in the interval for the same presenting problem risks rejection; this scenario may warrant an A190 instead.
- Failure to document the interim care by another physician in the patient's chart can lead to audit issues if the rationale for A196 is questioned.
Billing Tips
- Ensure the new written request for A196 clearly states the patient was seen by another physician in the interval for the same presenting problem.
- If the patient returns for follow-up on the same psychiatric issue without intervening care from another physician, bill A190 (Psychiatric consultation) instead of A196.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Psychiatry
Consultation
Requires a new written request from a referring physician, nurse practitioner, or dental surgeon (in connection with an insured dental procedure in a hospital).
The consultant must perform a general, specific, or medical specific assessment, including a review of all relevant data.
A written report (including findings, opinions, and recommendations) must be prepared and sent to the referring provider.
A copy of the signed written request must be kept in the consultant'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.
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 adjusted to a lesser assessment fee.
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