C476 – Repeat consultation - respiratory disease
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
C476 is a repeat consultation provided by a specialist in Respiratory Disease (47). This service is specifically for non-emergency in-patients in an acute care hospital, as indicated by the 'C' prefix (see ). A repeat consultation, as defined in , is an additional consultation rendered by the same consultant for the same presenting problem. A key requirement is that care must have been rendered to the patient by another physician in the interval following the initial consultation but preceding this repeat consultation. Like all consultations, this service requires a new written request from a referring physician, nurse practitioner, or dental surgeon. The consultant must perform an assessment, review relevant data, and provide a written report of findings, opinions, and recommendations to the referring practitioner. For full consultation requirements, see .
When to Use
- Use C476 when you have already provided an initial consultation (C475) for the same respiratory condition and a new written referral is obtained after another physician has intervened in the patient's care.
- Use C476 for a follow-up assessment of a hospitalized patient where the clinical complexity requires a formal consultation report rather than a subsequent visit (C473).
Common Pitfalls
- Billing C476 without a new, distinct written referral request from a referring practitioner will result in a rejection or downgrade to a subsequent visit code.
- Failing to document that another physician has provided care to the patient between your initial consultation and this repeat consultation is a common audit failure.
- Attempting to bill C476 for a routine follow-up where no new clinical problem or significant change in status has occurred; this should be billed as a subsequent visit (C473).
Billing Tips
- Ensure the written referral specifically requests a repeat consultation for the ongoing respiratory issue to satisfy the documentation requirements for C476.
- If you are seeing the patient in an ICU or CCU setting, remember to append the C101 premium to C476, as special visit premiums are strictly prohibited for 'C' prefix codes.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
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, signed by the referring practitioner, must be kept in the consulting physician's medical record. In hospitals with a common medical record, 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.
A written report, including findings, opinions, and recommendations, must be provided to the referring practitioner.
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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