A616 – Repeat Consultation
OHIP General Listings Code — Haematology (61) · 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 A616 when a patient returns for a follow-up on the same hematological issue after seeing another physician (e.g., their GP) for management of that specific issue in the interim.
- Use A616 if the patient was initially seen for a complex anemia (A615), their GP initiated iron therapy, and the patient now requires the consultant's reassessment of the anemia's cause and management plan.
- A616 is appropriate if a patient had an initial consultation for a bleeding disorder (A615), was managed by another specialist for a concurrent condition, and now needs the hematologist's opinion on the bleeding disorder again.
Common Pitfalls
- Billing A616 when the patient has not seen another physician for the same presenting problem since the initial A615 consultation; this would be an A615.
- Submitting A616 without a valid referral from a physician, NP, or dental surgeon, which is a requirement for all consultations.
- Using A616 when the patient has been managed by the same consultant since the initial A615; this scenario does not meet the criteria for a repeat consultation.
Billing Tips
- Ensure the interval physician's documentation clearly indicates they provided care for the same presenting problem that led to the initial A615 consultation.
- A616 is not subject to the 'one service per two consecutive 12 month periods' limit of A615, provided the criteria for a repeat consultation are met.
Effective: June 1, 2025
Consultations and Visits
Haematology (61)
Consultations and Visits
Consultation
A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner or dental surgeon in connection with an insured dental procedure rendered in a hospital.
The request identifies the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
The consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data.
A consultation includes the services necessary to enable the consultant to prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon. Where the referral is made by a nurse practitioner, the consultant shall provide the report to the nurse practitioner and the patient’s primary care provider, if applicable.
A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician’s medical record, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
For services not listed under Haematology, refer to the Internal Medicine section.
If the physician rendering the service requests a referral after the service has been provided, a consultation is not payable; the appropriate visit fee should be claimed instead.
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