A266 – 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
- A patient initially seen by you for a complex cardiac issue is referred back to their GP, who then refers them back to you after managing a new symptom related to the original cardiac problem.
- You consult on a patient for a neurological condition, another physician manages a concurrent issue, and the original neurologist then refers the patient back to you for follow-up on the initial neurological problem.
- A patient sees you for a rheumatological condition, is admitted to hospital and managed by hospitalists, and is then referred back to you for continued management of the original rheumatological condition post-discharge.
Common Pitfalls
- Billing A266 when no other physician has seen the patient for the same presenting problem in the interim; this should be billed as a regular consultation (e.g., A005).
- Failing to obtain a new written request from a referring physician, nurse practitioner, or dental surgeon for the repeat consultation, leading to claim rejection.
- Submitting A266 when the patient has not received care from another physician for the same presenting problem between the initial and repeat consultation, as this violates the core requirement of the code.
Billing Tips
- Ensure the repeat consultation is for the *same* presenting problem as the initial consultation; a new problem requires a new consultation code.
- Verify that the interval care provided by another physician was for the same presenting problem, not an unrelated issue, to meet the criteria for A266.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultation
Requires a new written request from a referring physician, nurse practitioner, or dental surgeon.
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.
The request must identify the consultant, the referring provider, and the patient by name and billing/health numbers.
A copy of the written request must be kept in the consultant's medical record.
A repeat consultation is used when the same consultant is asked to see the patient again for the same problem, but only if another physician has provided care for that problem in the interim.
If the requirements for a repeat consultation are not met, the service may be adjusted to a lesser assessment fee.
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