C056 – Repeat consultation
OHIP Surgical Procedures Code — COMMUNITY MEDICINE (05) · 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
- Use C056 when a patient is readmitted or requires a specialist reassessment for the same condition after a primary care physician or hospitalist has managed the patient in the interim.
- Use C056 when a patient's clinical status changes significantly for a previously consulted condition, provided a new written referral is obtained and another physician has provided care in the interval.
Common Pitfalls
- Billing C056 without a new, distinct written referral from the attending physician, which is a mandatory requirement for every repeat consultation.
- Submitting C056 when no other physician has provided care for the patient in the interval between the initial consultation and the current visit, which defaults the service to a subsequent visit (C052).
- Confusing C056 with a standard consultation (C055); C056 is specifically for repeat assessments where the 'care in the interval' criteria are met.
Billing Tips
- Ensure the referring physician's name and billing number are clearly documented in the chart to satisfy the referral requirement for audit purposes.
- If the 'care in the interval' requirement cannot be proven or a new referral is missing, bill as a medical specific assessment (C053) to avoid rejection.
Effective: June 1, 2025
A. Consultations and Visits
COMMUNITY MEDICINE (05)
Hospital Inpatient
Consultation
A new written request from a referring physician, nurse practitioner, or dental surgeon is mandatory.
The consultant must have previously seen the patient for the same problem.
Another physician must have provided care for the same problem in the interval between the initial and repeat consultation.
A written report including findings, opinions, and recommendations must be sent to the referring provider.
The consultant must perform a medical specific assessment and review 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.
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