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C116 – Repeat consultation

OHIP Consultations and Visits Code — CONSULTATIONS AND VISITS · Schedule of Benefits

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Levels of this visit

The C11x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

  • C114 Medical specific re-assessment

    A medical specific re-assessment is a service rendered by a specialist in Critical Care Medicine for a hospital in-patient.

    $72.00

  • C111 Complex medical specific re-assessment

    A complex medical specific re-assessment is a re-assessment of a patient because of the complexity, obscurity, or seriousness of the patient’s condition.

    $83.40

  • C113 Complex neurological assessment

    An assessment for the ongoing management of complex chronic neurological conditions where the complexity of the condition requires the continuing management by a neurologist and…

    $120.00

Consultations

  • C116 Repeat consultation(this code)

    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…

    $122.00
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 code specifically applies to services rendered to non-emergency hospital in-patients.
Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon
A new written request from a referring physician, nurse practitioner, or dental surgeon is mandatory.
The consultant must provide a written report (including findings, opinions, and recommendations) to the referring provider.
The service must include a general, specific, or medical specific assessment, including a review of all relevant data.
The request must identify the consultant, the referring provider (name and billing number), and the patient (name and health number).
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.
Usage limits
Consultations are typically limited to one per two consecutive 12-month periods for the same diagnosis; however, repeat consultations (C116) are an explicit exception to this limit. Note that hospital rules generally limit consultation-level fees to one per admission unless specific transfer or new-problem criteria are met.
A116Repeat consultation (General Listings/Out-patient)C715Consultation - non-emergency hospital in-patientC710Comprehensive critical care medicine consultationC915Limited consultation - non-emergency hospital in-patientC112Subsequent visit - first five weeks (per visit)

A repeat consultation requires that care was rendered to the patient by another physician in the interval between the initial consultation and the repeat consultation.

If the formal requirements for a consultation (like the written request) are not met, the fee will be adjusted to a lesser assessment fee.

The start and stop times are not explicitly required for C116 (unlike the comprehensive C710), but documentation of the assessment is mandatory.

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