C096 – Repeat consultation
OHIP Surgical Procedures Code — CARDIAC SURGERY (09) · Schedule of Benefits
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 C096 when a patient returns for a cardiac surgery evaluation after being managed by their primary care provider or another specialist for the same condition since your initial C095 consultation.
- Use C096 when a patient's cardiac status has evolved significantly enough to warrant a new formal consultation request from a referring physician, provided the patient received intervening care from another provider.
Common Pitfalls
- Billing C096 without a new, distinct written referral request from the referring physician, which is a mandatory requirement for all repeat consultations.
- Failing to document that another physician provided care to the patient in the interval between the initial consultation and the repeat consultation, leading to potential audit recovery.
- Submitting C096 for a routine follow-up visit where no intervening care by another physician occurred; such visits should be billed as a subsequent visit (e.g., C092) rather than a consultation.
Billing Tips
- Ensure the written referral request for C096 explicitly mentions the new clinical question or the change in the patient's status to justify the repeat consultation versus a standard follow-up visit.
- Always link the C096 to the specific referring physician's billing number and ensure your written report is sent back to that same provider to satisfy the core documentation requirement.
Effective: June 1, 2025
A. Consultations and Visits
CARDIAC SURGERY (09)
Cardiac Surgery (09)
Consultation
A new written request from a referring physician, nurse practitioner, or dental surgeon is mandatory.
The consultant must be competent to give advice in the field due to the complexity, seriousness, or obscurity of the case.
The service must include a review of all relevant data and the performance of a general, specific, or medical specific assessment.
A written report (findings, opinions, and recommendations) must be prepared and sent to the referring provider.
Care must have been rendered to the patient by another physician in the interval between the initial consultation and the repeat consultation.
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.
Non-Emergency Long-Term Care In-Patient Services includes Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, designated chronic or convalescent care beds in hospitals and nursing homes or homes for the aged, other than patients in designated palliative care beds.
If the requirements for a consultation (e.g., written request, report) are not met, the amount payable for a consultation will be reduced to a lesser assessment fee.
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