A226 – Repeat genetic 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 A226 when a patient returns for a follow-up genetic consultation on the same issue, and another physician has managed the patient's care since the initial A225 consultation.
- Use A226 if the patient was managed by a different specialist for the same genetic condition between the initial A225 consultation and the subsequent consultation.
- A226 is appropriate when a geneticist needs to re-evaluate a patient's condition due to new developments or a change in management by another provider, following an initial A225 consultation.
Common Pitfalls
- Billing A226 when the patient has not been seen by another physician in the interval since the initial consultation; this scenario may warrant an A225 if the two-year limit has passed, or no consultation code if within the limit.
- Submitting A226 when the consultant has continued to manage the patient's care directly, as this code requires a gap in management by another physician.
- Failing to obtain a new, distinct written request from a referring physician, NP, or dental surgeon for the repeat consultation, which is a mandatory requirement for A226.
Billing Tips
- Ensure the documentation clearly states the interval management by another physician, as this is the defining criterion for A226 over A225.
- Verify that the repeat consultation addresses the same presenting problem as the initial consultation to meet the definition of A226.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Genetics (22)
Consultation
A new 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 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.
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.
If the requirements for a consultation (e.g., written request or report) are not met, the fee will be adjusted to a lesser assessment fee.
A repeat consultation cannot be billed if the consultant has been providing ongoing management; it requires care by another physician in the interval.
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