C066 – 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. A repeat consultation has the same requirements as a consultation including the requirement for a new written request by the referring physician, <medicalTerm>nurse practitioner</medicalTerm> or <medicalTerm>dental surgeon</medicalTerm>. A consultation is an assessment rendered following a written request from a referring provider who, in light of his/her professional knowledge of the patient, requests the opinion of a physician (the 'consultant physician') competent to give advice in this field because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or patient's representative. A consultation includes the services necessary to enable the consultant to prepare a written report (including findings, opinions, and recommendations) to the referring provider. Except where otherwise specified, the consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data. This service is for a non-emergency repeat consultation rendered to a hospital in-patient by a specialist in Orthopaedic Surgery.
When to Use
- Use C066 when you have already provided an initial consultation (A066) for a specific problem, and the patient has since been managed by another physician (e.g., the primary care provider or a hospitalist) before you are requested to reassess the same condition.
- Use C066 when a patient's condition has evolved or worsened, necessitating a new formal written request for your expert opinion, provided the patient was under the care of another physician in the interim.
Common Pitfalls
- Billing C066 without a new, distinct written request from the referring provider; a simple verbal request or a note in the chart is insufficient to meet the consultation requirement.
- Confusing C066 with a subsequent hospital visit (C062); C066 requires a formal referral and a written report, whereas subsequent visits do not.
- Failing to document that the patient was under the care of another physician between your initial consultation and this repeat request, which is a mandatory criterion for the 'repeat' designation.
Billing Tips
- Ensure your written report is sent directly to the referring provider and clearly documents the findings, opinion, and recommendations to satisfy the core consultation requirement.
- Keep the written referral request on file or ensure it is clearly identifiable in the hospital's common medical record to survive a potential audit.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
A repeat consultation has the same requirements as a consultation including the requirement for a new written request by the referring physician, nurse practitioner or dental surgeon.
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. In a hospital where common medical records are maintained, the written request may be contained on the common medical record.
The request must identify the consultant by name, the referring provider by name and billing number, and the patient by name and health number.
The written request must set out the information relevant to the referral and specify the service(s) required.
The consultant must prepare a written report (including findings, opinions, and recommendations) to the referring provider.
NON-EMERGENCY HOSPITAL IN-PATIENT SERVICES. For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable.
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