C086 – 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. This specific code (C086) applies to Plastic Surgery (08) services rendered to non-emergency hospital in-patients.
When to Use
- Use C086 when a patient is re-referred by another physician for a plastic surgery issue that was previously consulted on, provided the patient received intervening care from a different physician.
- Use C086 for a follow-up assessment on an existing plastic surgery inpatient issue where the referring physician has actively managed the patient's care in the interim, necessitating a formal re-evaluation.
Common Pitfalls
- Billing C086 without a new, distinct written referral request from the referring physician, which will trigger a rejection or audit recovery.
- Attempting to bill C086 for routine follow-up rounds where no intervening care by another physician has occurred, which instead requires a subsequent visit code.
- Confusing C086 with C085; C086 requires an intervening period of care by another physician, whereas C085 is for the initial consultation.
Billing Tips
- If you are the Most Responsible Physician (MRP) performing the admission assessment, ensure you append premium E082 to the C086 claim to increase the fee by 30%.
- Always maintain the new written referral in the patient's chart to substantiate the 'repeat' nature of the consultation during an audit.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultation
Age-based fee premiums (10% to 30%) apply for patients under 16 years of age.
If the requirements for a repeat consultation are not met (e.g., no new referral or no care by another physician in the interval), the fee will be adjusted to a lesser assessment fee.
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