C356 – Repeat consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A hospital in-patient repeat consultation by a urologist, which is an additional consultation rendered by the same consultant for the same presenting problem. This service is appropriate only after another physician has provided care in the interval following the initial consultation but preceding the repeat consultation. It requires a new written request from a referring physician, nurse practitioner, or dental surgeon as defined in . The service includes all the specific elements of an assessment as outlined in , including a direct physical encounter, history, and examination. A written report with findings, opinions, and recommendations must be sent to the referring practitioner. The 'C' prefix indicates this service is for non-emergency, acute care hospital in-patients. For payment requirements and documentation, see and .
When to Use
- Use C356 when a urologist is asked to re-evaluate a patient for the same presenting problem after another physician has provided active care in the interim.
- Use C356 when a new written referral request is received for a patient previously seen by you for the same condition, provided the 'active care' interval requirement is met.
Common Pitfalls
- Billing C356 without a new written referral request from a physician, nurse practitioner, or dental surgeon, which will trigger a rejection or audit recovery.
- Claiming C356 for a follow-up visit where no other physician provided care in the interval, as this should be billed as a subsequent hospital visit (C002) instead.
- Failing to send a formal written report to the referring practitioner, which is a mandatory requirement to maintain the 'Consultation' status of the code.
Billing Tips
- Ensure the referring practitioner's name and billing number are clearly documented in your chart to satisfy the audit requirements for a valid referral.
- If the patient is in an ICU or CCU, remember to add the C101 premium to your C356 claim to capture the additional intensity of the setting.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
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 (unless in a common medical record where the written request may be contained on the common medical record).
The request must identify the consultant by name, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identify 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 physician, nurse practitioner or dental surgeon.
The asterisk * next to the listing indicates that age-based fee premiums may apply to this service as per .
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