A636 – Repeat Consultation
OHIP General Listings Code — Nuclear Medicine (63) · 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 A636 when a patient is referred back to you for the same nuclear medicine issue after seeing another physician for interval care, and you are providing a new assessment and report.
- Use A636 if the patient's condition has evolved and requires a new assessment and report from you, following a previous consultation (A635) and intervening care by another physician.
- A636 is appropriate when a referring physician requires your expert opinion on a nuclear medicine issue again, after another physician has managed the patient in the interim.
Common Pitfalls
- Billing A636 when the patient has not seen another physician for interval care since your initial consultation (A635); this scenario should be billed as a regular consultation (A635) or assessment.
- Failing to obtain and retain a new written request for the repeat consultation, which is a mandatory requirement for A636.
- Billing A636 when the intervening physician's care was not for the same presenting problem as the initial consultation (A635).
Billing Tips
- Ensure the documentation clearly outlines the intervening care provided by another physician between your initial consultation (A635) and this repeat consultation (A636).
- Verify that the written report for A636 includes findings, opinions, and recommendations specifically addressing the patient's current status and the reason for the repeat consultation.
Effective: June 1, 2025
Consultations and Visits
Nuclear Medicine (63)
Nuclear Medicine
Consultation
A new written request from a referring physician, nurse practitioner, or dental surgeon is required.
The consultant must prepare a written report including findings, opinions, and recommendations to the referring provider.
The consultant is required to perform a general, specific, or medical specific assessment, including a review of all relevant data.
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.
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 written request sets out the information relevant to the referral and specifies the service(s) required.
If the requirements for a consultation (e.g., written request, written report) are not met, the amount payable will be adjusted to a lesser assessment fee.
A repeat consultation is not eligible for payment if the physician has been paid for a consultation for the same diagnosis and makes a request for a referral for ongoing management (except as outlined in Virtual Care definitions).
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