C046 – Repeat consultation
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. It has the same requirements as a consultation, including a new written request from the referring physician, nurse practitioner, or dental surgeon. This service is for a non-emergency hospital in-patient and is rendered by a physician with a specialty in Neurosurgery. Consultation Requirements 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 is made because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or patient's representative. The consultation includes all services necessary for the consultant to prepare a written report (including findings, opinions, and recommendations) to the referring provider. The consultant must perform a general, specific, or medical specific assessment, including a review of all relevant data.
When to Use
- Use C046 when a patient requires a follow-up neurosurgical opinion on the same presenting problem after another physician (e.g., an intensivist or hospitalist) has intervened or managed the patient since your initial consultation.
- Use this code when the 12-month limit for a standard consultation has been reached, provided the specific requirement of intervening care by another physician is met.
Common Pitfalls
- Billing C046 without clear documentation of intervening care by another physician, which is a mandatory requirement to distinguish it from a subsequent visit (A046).
- Failing to obtain a new written request from the referring physician or nurse practitioner, as C046 requires the same formal referral process as an initial consultation.
- Using C046 for routine follow-up visits where no other physician has provided care in the interim; these should be billed as subsequent hospital visits (A046).
Billing Tips
- Ensure the medical record explicitly notes the name of the physician who provided care in the interval to satisfy the audit requirement for this specific code.
- Always link the new written request to the C046 claim in your records to support the 'repeat' status during a potential ministry review.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
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 consultant must 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. Except where otherwise specified, the consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data.
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.
See General Preamble to for rules regarding non-emergency hospital in-patient services.
A repeat consultation is an exception to the limit of one consultation per two consecutive 12 month periods for the same diagnosis.
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