C196 – Repeat Consultation
OHIP Surgical Procedures Code — Psychiatry (19) · 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. It has the same requirements as a consultation, including a new written request from a referring physician, nurse practitioner, or dental surgeon. As a 'C' prefix code, this service is for non-emergency hospital in-patients. The service includes the services necessary to enable the consultant to prepare a written report (including findings, opinions, and recommendations) to the referring practitioner.
When to Use
- Use C196 when a patient has been seen by another physician (e.g., the attending or a different specialist) for the same psychiatric issue since your initial consultation, and you are now being re-consulted.
- Use this code for a follow-up hospital in-patient psychiatric assessment when a new, formal written request has been generated by the attending physician or nurse practitioner to address the same presenting problem.
Common Pitfalls
- Billing C196 without a new, distinct written referral request from the attending practitioner, which is a mandatory requirement for every repeat consultation.
- Attempting to bill C196 when you have been providing ongoing, continuous care; if there was no intervening care by another physician, this is a subsequent visit (e.g., C195), not a repeat consultation.
- Failing to document a new, specific clinical question or request for opinion, as simply seeing the patient again for the same issue without a new referral request does not qualify as a repeat consultation.
Billing Tips
- Ensure the referring physician's name and billing number are clearly documented in the patient's chart alongside the new written request to satisfy audit requirements.
- If you are seeing the patient for a different psychiatric diagnosis than the initial consultation, consider whether a new initial consultation (C195) is more appropriate than a repeat consultation (C196).
Effective: June 1, 2025
Consultations and Visits
Psychiatry (19)
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
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 consultant must prepare a written report including findings, opinions, and recommendations to the referring physician, nurse practitioner or dental surgeon.
See General Preamble to . For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
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