C076 – 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.
When to Use
- Use C076 when a patient is readmitted or seen in hospital for the same condition after a primary care physician or hospitalist has managed the patient's care in the interim.
- Use C076 when a specialist is re-engaged for the same presenting problem following a period of care provided by another physician, distinguishing it from a standard follow-up visit (e.g., C075 or subsequent hospital visits).
- Use C076 when the patient's clinical status has changed significantly enough to warrant a new formal consultation request from a referring provider, despite the previous involvement of the specialist for the same issue.
Common Pitfalls
- Billing C076 without a new, distinct written request from the referring provider will lead to audit recovery, as it is not a standing order or a routine follow-up.
- Attempting to bill C076 when no other physician has provided care in the interval between the initial consultation and the repeat request violates the core definition of the code.
- Confusing C076 with subsequent hospital visits (e.g., C002) is a common error; C076 requires a formal consultation report and a specific referral, whereas subsequent visits do not.
Billing Tips
- Ensure the referring physician's billing number is clearly documented on the new written request to satisfy the mandatory audit trail for C076.
- If the patient is seen via video, append the 'A' suffix (C076A) to ensure the claim is processed correctly under virtual care guidelines.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
In-patient
Consultation
A repeat consultation is specifically for the same presenting problem when another physician has provided care in the interval since the initial consultation.
If a consultant is referred to the same patient a second time for the same diagnosis but the 'repeat consultation' criteria (interval care by another physician) are not met, the service may be limited by the 1-per-24-month rule unless it occurs between 12-24 months for a hospital in-patient.
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