All codes
A416
A416 – Repeat Consultation
OHIP General Listings Code — Gastroenterology (41) · 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 A416 when a patient with Crohn's disease (555) is referred back for a repeat consultation after seeing their family physician for a new symptom flare, and you provided the initial A415 consultation.
- Use A416 if a patient with chronic liver disease (571) was managed by another specialist for a complication, and now requires your repeat consultation for the original liver issue.
- A416 is appropriate when a patient with malnutrition (263) has been managed by a dietitian between your initial consultation (A415) and this subsequent visit for the same nutritional deficiency.
Common Pitfalls
- Submitting A416 without a new, signed referral from the referring provider will result in fee adjustment to a lesser assessment.
- Billing A416 when the patient has not been seen by another physician for the same problem since your initial consultation will lead to payment adjustment.
- Failure to include one of the mandated diagnostic codes (263, 555, 556, 571, or 579) on the claim will cause rejection.
Billing Tips
- Ensure the report sent to the referring provider clearly outlines intervening care by another physician and the rationale for the repeat consultation.
- Remember that A416 is the outpatient equivalent of C416; use C416 for inpatient repeat consultations.
Provider Fee$0.00
Specialist Fee$105.25
Effective: June 1, 2025
Category
Consultations and Visits
Subcategory
Gastroenterology (41)
Service Type
Consultations and Visits
Code Classes
Consultation
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