C026 – Repeat consultation
OHIP Surgical Procedures 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
- Use C026 when you have provided an initial consultation (C025), the patient was subsequently managed by the attending physician or another specialist, and you are now requested to provide a new opinion on the same original problem.
- Use C026 for a follow-up assessment that requires a formal written request and report, specifically when the patient's clinical status has changed significantly enough to warrant a new consultation rather than a subsequent visit (C028).
Common Pitfalls
- Billing C026 without a new, distinct written referral request from the attending physician, which is a mandatory requirement for this code.
- Using C026 for routine follow-up visits where no other physician has managed the patient in the interim; these should be billed as subsequent hospital visits (C028).
- Failing to document the specific involvement of another physician in the interval, which is a key audit trigger for justifying the 'repeat' status.
Billing Tips
- Ensure your chart documentation explicitly references the new referral request and the specific interval care provided by the other physician to satisfy the Ministry's audit criteria.
- Always verify that the referring provider is documented in the claim, as C026 is strictly dependent on the existence of a formal request for a repeat opinion.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
In-patient
Consultation
A new written request from a referring physician, nurse practitioner, or dental surgeon is required.
The consultant must prepare a written report (findings, opinions, and recommendations) to the referring provider.
The service must include a general, specific, or medical specific assessment, including a review of all relevant data.
Care must have been rendered to the patient by another physician in the interval between the initial consultation and the repeat consultation.
The consultant must be the same physician who performed the initial consultation.
If the requirements for a repeat consultation are not met, the amount payable will be adjusted to a lesser assessment fee.
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