C156 – Repeat consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service is a repeat consultation for a non-emergency hospital in-patient, rendered by a specialist in Endocrinology & Metabolism (15). The 'C' prefix indicates the service location is an acute care hospital for a non-emergency in-patient service (). A repeat consultation is defined as 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 (). It requires a new written request from the referring physician, nurse practitioner, or dental surgeon. All requirements for a consultation, as detailed in , apply, including the specific elements of assessments outlined in .
When to Use
- Use C156 when you have already provided an initial consultation (C150) for the same endocrine condition, and the patient has since been managed by another physician (e.g., the attending hospitalist) before requiring your specialist re-evaluation.
- Use C156 for a new, distinct endocrine problem in an existing inpatient that requires a formal written request, provided the patient has been under the care of another physician in the interim.
Common Pitfalls
- Billing C156 without a new, formal written request from the referring physician or nurse practitioner will lead to a clawback during an audit.
- Using C156 for a follow-up visit where no other physician has managed the patient in the interim is incorrect; such visits should be billed as subsequent hospital visits (C153).
- Failing to document the specific 'intervening care' by another physician makes the claim vulnerable to rejection, as this is a mandatory definition of a repeat consultation.
Billing Tips
- Ensure the written request explicitly states the reason for the repeat consultation to satisfy the documentation requirements for a formal referral.
- Always verify that the referring physician's name and billing number are included on the claim to prevent administrative rejections.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
A repeat consultation has the same requirements as a consultation including the requirement for a new written request by the referring physician, nurse practitioner or dental surgeon.
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. In a hospital where common medical records are maintained, the written request may be contained on the common medical record.
The request must identify the consultant by name, the referring physician/nurse practitioner/dental surgeon by name and billing number, and the patient by name and health number.
The written request must set out the information relevant to the referral and specifies the service(s) required.
The consultant must prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon.
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