A246 – 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 A246 when a patient returns for the same ENT issue after seeing their family physician for a new concern or treatment between your initial consultation (A245) and this follow-up.
- Use A246 if the patient was managed by another physician (e.g., GP, another specialist) for the same presenting problem after your initial A245, and you are now seeing them again for that same problem.
- A246 is appropriate if the patient saw another physician for the same ENT issue, and you are providing a subsequent consultation on that same issue, not just a routine follow-up visit.
Common Pitfalls
- Billing A246 instead of A245 when there was no intervening care by another physician for the same presenting problem.
- Submitting A246 when the patient's subsequent management was by the same consultant without intervening care from another physician, which should be billed as a visit code (e.g., A243).
- Failing to document the intervening care by another physician in the interval, which is a key requirement for A246.
Billing Tips
- Ensure the written report to the referring provider clearly outlines the findings, opinions, and recommendations related to the presenting problem.
- Verify that the referral request explicitly names the consultant and specialty, the referring provider with their billing number, and the patient's health number.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Otolaryngology (24)
Consultation
The consultant must prepare 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. 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.
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