C036 – Repeat consultation - non-emergency hospital in-patient
OHIP Surgical Procedures 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. This specific code (C036) applies to non-emergency hospital in-patients.
When to Use
- Use C036 when you have previously consulted on a patient, the patient was subsequently managed by the MRP or another specialist, and you are now requested to re-evaluate the same condition.
- Use C036 when a patient's clinical status has significantly changed after a period of management by another physician, necessitating a formal re-consultation rather than a routine C034 re-assessment.
Common Pitfalls
- Billing C036 without a new, formal written referral request from the referring physician, which is a mandatory requirement for repeat consultations.
- Attempting to bill C036 when you have been the sole provider managing the patient; the code requires an interval of care provided by another physician.
- Submitting C036 for a patient already seen by you during the same hospital admission, as only one consultation or assessment is payable per admission.
Billing Tips
- Ensure the referring physician's name and billing number are clearly documented on the new referral request to satisfy audit requirements for the repeat consultation.
- If the criteria for a repeat consultation are not met, bill a C034 (specific re-assessment) instead to avoid a rejection or an automatic adjustment to a lower fee.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Specialist
Consultation
The consultant must prepare a written report (findings, opinions, recommendations) and send it to the referring provider.
A new written request is required for a repeat consultation.
The request must identify 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.
If the admitting physician has previously assessed the patient for the same presenting illness within 90 days of the admission assessment, the admission assessment constitutes a re-assessment, not a consultation.
For emergency calls or special visits to in-patients, use General Listings and Premiums ( to ) instead of 'C' prefix codes.
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