C266 – Paediatric 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 provided to a non-emergency hospital in-patient. The consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data, and prepare a written report with findings, opinions, and recommendations for the referring provider.
When to Use
- Use C266 when a patient has been seen by a different physician (e.g., a hospitalist or GP) for the same presenting problem after your initial C265 consultation, and you are now re-evaluating the patient.
- Use this code when a new, distinct written referral is received for a patient you previously consulted on, provided the patient was managed by another provider in the interim.
Common Pitfalls
- Billing C266 without a new, formal written request from the referring provider will result in a downgrade to a standard hospital visit fee.
- Claiming C266 when the patient has not been under the care of another physician between your initial consultation and this visit fails the 'interval care' requirement.
- Confusing C266 with a subsequent hospital visit (C662) when no new referral has been requested or when the patient has not been managed by another provider in the interim.
Billing Tips
- Ensure the referring provider's request explicitly mentions the need for a repeat consultation to address the ongoing or changed clinical status of the patient.
- Always document the name of the physician who provided the interval care, as this is a prerequisite for the 'repeat' status of the consultation.
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. In a hospital where common medical records are maintained, the written request may be on the common medical record.
The request must identify the consultant by name, the referring provider 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 specify the service(s) required.
The consultation includes the services necessary to enable the consultant to prepare a written report (including findings, opinions, and recommendations) to the referring provider.
Repeat consultations are not subject to the same frequency limits as initial consultations.
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