C186 – Repeat consultation
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. 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. As a 'C' prefix code, this service is for non-emergency in-patient services in an acute care hospital. As per , a consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon in connection with an insured dental procedure rendered in a hospital. The consultant physician provides an opinion because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or patient's representative. A written report of findings, opinions, and recommendations must be sent to the referring practitioner.
When to Use
- Use C186 when a patient has been discharged from your care, treated by another physician (e.g., a hospitalist or primary care provider) for the same condition, and you are subsequently re-consulted for that same problem.
- Use C186 when a patient's condition has significantly evolved or deteriorated during their hospital stay, requiring a new formal written request from the attending physician to provide a fresh opinion on the same original diagnosis.
Common Pitfalls
- Billing C186 for a routine follow-up visit where no intervening care by another physician has occurred; this should be billed as a subsequent visit (C002/C007) instead.
- Failing to secure a new, distinct written referral request for the repeat consultation, which is a mandatory requirement even if you are the same consultant who provided the initial C185.
- Submitting C186 without documenting the specific intervening care provided by another physician, which is the primary audit trigger for this code.
Billing Tips
- Ensure your documentation explicitly references the 'intervening care' provided by another practitioner to satisfy the specific definition of a repeat consultation.
- If you cannot prove that another physician provided care in the interval between your initial consultation and the current visit, default to a standard subsequent hospital visit code to avoid rejection or clawback.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, 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, 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, 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.
A written report including findings, opinions, and recommendations must be prepared and sent to the referring physician, nurse practitioner or dental surgeon.
See General Preamble to for rules regarding non-emergency hospital in-patient services.
For emergency calls and other special visits to in-patients, use General Listings ('A' prefix codes) and Premiums when applicable - see General Preamble to .
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