C486 – 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 full consultation, including a new written request from a referring practitioner, a comprehensive assessment, and a written report of findings and recommendations to the referring source.
When to Use
- Use C486 when you are re-evaluating a patient for the same condition after a period of active management by another physician (e.g., a primary care provider or another specialist) following your initial consultation.
- Use C486 when a patient returns for a new consultation on the same condition after a significant interval where the patient was under the care of a different physician, provided a new written referral is obtained.
Common Pitfalls
- Billing C486 without a new written referral from the referring practitioner; a repeat consultation requires a fresh request, unlike a standard follow-up visit.
- Failing to document a comprehensive assessment and a new written report to the referring physician, which are mandatory requirements for C486, unlike a routine A486 or subsequent hospital visit.
- Using C486 for a routine follow-up visit where no other physician has intervened in the patient's care; this should be billed as a subsequent visit or a specific follow-up code.
Billing Tips
- Ensure your documentation explicitly references the new referral request and the intervening care provided by another physician to justify the 'repeat' status over a standard consultation.
- Always confirm the referring physician's billing number is included in your records, as this is a specific requirement for the validity of the C486 claim.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
A new written request from the referring practitioner must be maintained in the patient's medical record.
The request must identify the consultant, the referring practitioner by name and billing number, and the patient by name and health number.
The request must set out relevant clinical information and specify the service(s) required.
The consultant must prepare a written report including findings, opinions, and recommendations for the referring practitioner.
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