A626 – Repeat Consultation
OHIP General Listings Code — Clinical Immunology (62) · 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 A626 when a patient is referred back to you for the same complex immunological issue after seeing another physician (e.g., a rheumatologist) for a specific intervention or diagnostic workup in the interim.
- Use A626 if a patient initially saw you for a rare autoimmune condition, was managed by their GP for a related infection, and then returns to you for reassessment of the original autoimmune condition.
- A626 is appropriate when a patient sees another specialist for a different condition, and then returns to you for follow-up on the original immunological problem that required your initial consultation.
Common Pitfalls
- Billing A626 when the patient has not seen another physician for the same presenting problem in the interval; this scenario would typically be billed as A625 or A525.
- Failing to document the specific 'care in the interval' provided by another physician in the patient's chart, which is a key differentiator for A626.
- Submitting A626 without a written report sent to the referring provider, which can lead to fee adjustment to a lesser assessment.
Billing Tips
- Ensure the referral documentation clearly indicates the patient was seen by another physician for the same presenting problem between your initial consultation and this repeat consultation.
- Clearly differentiate the 'care in the interval' from routine follow-up by another physician; it must be a distinct intervention or assessment related to the original problem.
Effective: June 1, 2025
Consultations and Visits
Clinical Immunology (62)
Consultations and Visits
Consultation
Written report sent to the referring provider.
Must include a medical specific assessment.
Request must be documented in the medical record.
If consultation requirements (request/report) are not met, the fee will be adjusted to a lesser assessment fee.
A626A is designated as Video Only in Appendix J.
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