C466 – Repeat consultation - infectious disease, non-emergency hospital in-patient
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. It has the same requirements as a consultation, including the need for a new written request from a referring practitioner. The 'C' prefix indicates the service is rendered to a non-emergency in-patient in an acute care hospital. See for the definition of repeat consultation and for full consultation requirements.
When to Use
- Use C466 when you are re-evaluating a patient for the same infectious disease problem after the primary team or another specialist has managed the patient for a period following your initial consultation.
- Use C466 when a patient's clinical status changes significantly enough to warrant a new formal consultation request from the attending physician, provided the patient remains an acute care in-patient.
Common Pitfalls
- Billing C466 without a new, distinct written referral request in the chart, which is mandatory for every repeat consultation regardless of the previous relationship.
- Failing to document that another physician provided active care in the interval between your initial consultation and this repeat, which is a strict requirement under GP19.
- Using C466 for routine follow-up visits; if there is no new referral or no intervening care by another physician, the service must be billed as a subsequent hospital visit (C465) instead.
Billing Tips
- Ensure your documentation explicitly references the new written request and the intervening care provided by the referring physician to satisfy audit requirements for the 'repeat' status.
- If you are seeing the patient in an ICU or CCU setting, remember to append the C101 premium to your C466 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
A new written request from the referring physician, nurse practitioner, or dental surgeon is required and must be kept in the patient's medical record. In a hospital with common medical records, the request may be on the common record.
The written request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number.
The written request must outline the relevant information for the referral and specify the service(s) required.
A written report including findings, opinions, and recommendations must be prepared and sent to the referring practitioner.
A repeat consultation is an exception to the limit of one consultation per two consecutive 12-month periods for the same diagnosis.
A new written referral is required for a repeat consultation.
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