A316 – 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 A316 when a patient returns for follow-up on the same issue after seeing another physician (e.g., GP referred to specialist, then GP saw patient again for a new issue before specialist's repeat consult).
- Use A316 if the initial consultation (A315) was for a specific problem, and an intervening physician's assessment necessitates a further consultation by the original consultant for that same problem.
- A316 is appropriate when the patient's condition has evolved or requires re-evaluation by the same consultant after another physician has managed the patient in the interim, for the same presenting complaint.
Common Pitfalls
- Billing A316 without a new, written referral from a physician, NP, or dental surgeon, or if the referral is for a different problem than the initial consultation.
- Submitting A316 when the interval physician care was not for the same presenting problem as the initial consultation, or if no physician saw the patient in the interval.
- Failing to send a comprehensive report with findings, opinions, and recommendations to the referring provider; this can lead to fee adjustment to a lesser assessment.
Billing Tips
- Ensure the medical record clearly documents the intervening physician's assessment and the reason for the repeat consultation on the same problem.
- A316 is not subject to the 12-month limit of A315, allowing for more frequent repeat consultations if medically justified by intervening care from another physician.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Physical Medicine & Rehabilitation
Consultation
A new written request from a referring physician, nurse practitioner, or dental surgeon is required.
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 sent to the referring provider.
The consultant's medical record must contain a copy of the signed written request (except in hospitals/LTC with common records).
The request must identify the consultant, the referrer (name and billing number), and the patient (name and health number).
A repeat consultation is only valid if another physician provided care for the same problem in the interval between the initial consultation and the repeat consultation.
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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