A466 – Infectious Disease Repeat Consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
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 A466 when a patient returns for follow-up on the same infectious disease issue after seeing their family physician for a new problem or management between your initial A465 consultation and this repeat visit.
- Use A466 if the patient was managed by another physician (e.g., hospitalist, another specialist) for a different issue or for a brief period for the same issue, and you are now seeing them again for the original infectious disease concern.
- This code is appropriate when the patient's primary care physician has initiated a new course of management or treatment for a separate condition, and the infectious disease specialist is providing a subsequent assessment for the original infectious disease problem.
Common Pitfalls
- Billing A466 when the patient has not seen another physician in the interval; this scenario would likely be an A465 or A460.
- Failing to obtain a new, separate written referral for the repeat consultation; the original referral is insufficient.
- Submitting A466 when the intervening care by another physician was for the same presenting problem and constituted ongoing management by the original consultant; this is not payable as a repeat consultation.
Billing Tips
- Ensure the new written request clearly indicates that intervening care by another physician has occurred since your last consultation for the same presenting problem.
- Verify that the intervening care was not simply a continuation of your own management plan, but rather involved another physician's assessment or treatment.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Specialist
Consultation
A new written request from a referring physician, nurse practitioner, or dental surgeon is required.
The consultant must be competent to give advice in the field due to the complexity, seriousness, or obscurity of the case.
The service must include a general, specific, or medical specific assessment.
A written report (findings, opinions, and recommendations) must be sent to the referring provider.
The written request must be signed and kept in the consultant's medical record (except in hospitals with common records).
The request must identify the consultant, referring provider (name and billing number), and patient (name and health number).
The request must specify the service required and relevant clinical information.
A repeat consultation is only payable if care was rendered to the patient by another physician in the interval between the initial consultation and the repeat consultation.
If the physician who was paid for a consultation makes a request for a referral for ongoing management, the subsequent service is not payable as a consultation.
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