C116 – Repeat consultation - non-emergency hospital in-patient
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 code specifically applies to services rendered to non-emergency hospital in-patients.
When to Use
- Use C116 when a patient has been seen by a different physician for the same problem following your initial consultation (e.g., C715) and you are re-evaluating the patient at the request of the attending physician.
- Use this code when a significant change in the patient's clinical status necessitates a formal re-consultation, provided an intervening physician has managed the patient in the interim.
Common Pitfalls
- Billing C116 without a new, formal written request from the referring provider, which is a mandatory requirement for every repeat consultation.
- Claiming C116 when you have been the sole provider of care for that problem, as the code explicitly requires an intervening period of care by another physician.
- Attempting to bill C116 on the same day as other consultation or assessment codes, which will trigger an automatic rejection.
Billing Tips
- Ensure your documentation explicitly references the intervening care provided by another physician to justify the 'repeat' status and differentiate it from a standard subsequent visit (C112).
- If a formal written request is missing, do not bill C116; instead, bill a subsequent hospital visit (C112) to avoid audit recovery.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Critical Care Medicine
Consultation
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.
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.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.