C176 – 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, as per . 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. This service is for a non-emergency hospital in-patient and is rendered by a specialist in Vascular Surgery (17).
When to Use
- Use C176 when you have already provided an initial consultation (C175) for a specific vascular condition, and the patient has since been managed by another physician (e.g., the attending hospitalist) before requiring your re-evaluation.
- Use C176 when a new, distinct written referral request is received for the same presenting problem after a period of care by another provider, effectively resetting the consultation eligibility for that diagnosis.
Common Pitfalls
- Billing C176 without a new, formal written referral request on file; unlike subsequent hospital visits (C172), a repeat consultation strictly requires a new referral.
- Attempting to bill C176 when you have been providing continuous, uninterrupted care for the same problem, as this fails the requirement that another physician must have provided care in the interval.
- Confusing C176 with C172; C176 is a consultation fee and requires a formal referral, whereas C172 is a subsequent visit fee that does not.
Billing Tips
- Ensure the referring physician's name and billing number are clearly documented for every C176 claim to satisfy the mandatory referral requirement.
- If the referral criteria for a consultation are not met, downgrade the claim to the appropriate subsequent hospital visit code (C172) to avoid total rejection.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Hospital and Institutional Consultations and Assessments
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 identifies the consultant by name, 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.
The 'C' prefix indicates a non-emergency hospital in-patient service.
A repeat consultation is an exception to the limit of one consultation per two consecutive 12-month periods for the same diagnosis.
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