A476 – 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 A476 when a patient is referred back to you for the same presenting problem after seeing another physician for interim care, and you are providing a new assessment and report.
- Use A476 if you previously consulted on a patient's condition, another physician managed them, and the patient is now referred back to you for the same issue.
- A476 is appropriate when a new referral request is received for a patient you've seen for the same issue, provided another physician intervened between your consultations.
Common Pitfalls
- Billing A475 (Consultation) instead of A476 when the criteria for a repeat consultation are met, leading to potential claim rejection or adjustment.
- Failure to obtain a new, written referral from the referring provider for each A476 service, which is a mandatory documentation requirement.
- Not sending a written report of findings, opinions, and recommendations to the referring provider after rendering an A476 service, risking audit or claim review.
Billing Tips
- Ensure the interim care by another physician is clearly documented in the patient's chart to support the A476 billing.
- For virtual repeat consultations, always append the 'A' suffix and confirm the service was delivered via video, as telephone is not permitted.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Consultation
A new written request from the referring provider is mandatory.
The consultant must prepare a written report (findings, opinions, and recommendations) and send it to the referring provider.
The consultant must perform a general, specific, or medical specific assessment as part of the service.
The medical record must contain a copy of the signed written request, identifying the consultant, referring provider, and patient.
A repeat consultation is specifically for cases where the same consultant is seeing the patient again for the same problem after another physician has provided care in the interval.
If the requirements for a repeat consultation are not met, the claim may be adjusted to a lesser assessment fee.
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