C316 – Repeat consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A repeat consultation is an additional consultation rendered by the same consultant for the same presenting problem, following care provided to the patient by another physician in the interval after the initial consultation. Like all consultations, it requires a new written request from a referring physician, nurse practitioner, or eligible dental surgeon. The C prefix designates this service for non-emergency in-patients in an acute care hospital. The consultant is required to perform an assessment and provide a written report to the referring practitioner. See : for the full definition of a repeat consultation and : for general consultation requirements.
When to Use
- Use C316 when you are re-assessing an inpatient for the same presenting problem after a period of care provided by the primary attending physician or another specialist.
- Use C316 for a follow-up consultation in an acute care hospital when a new written request is received, distinguishing it from a standard subsequent visit (C002) which does not require a referral.
Common Pitfalls
- Billing C316 without a new, formal written request from the referring practitioner will result in a downgrade to a standard subsequent visit fee upon audit.
- Failing to document a written report sent back to the referring practitioner is a frequent cause for recovery of funds during OHIP audits.
- Confusing C316 with a standard consultation (C003); C316 is specifically for repeat assessments of the same problem, whereas C003 is for the initial assessment.
Billing Tips
- Ensure the referring practitioner's billing number is clearly recorded on the consultation note to satisfy the mandatory documentation requirements.
- If the patient is in an ICU or CCU, remember to append the C101 premium to the C316 claim to maximize the value of the service.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
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 practitioner/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 specify the service(s) required (:).
The consultant must prepare a written report (including findings, opinions, and recommendations) to the referring practitioner (:).
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