C616 – Repeat Consultation
OHIP Surgical Procedures Code — Haematology (61) · 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 consultation, including the requirement for a new written request from the referring physician, nurse practitioner, or dental surgeon. The 'C' prefix indicates this service is for non-emergency hospital in-patients. See for the full definition of a repeat consultation and through for rules regarding 'C' prefix services.
When to Use
- Use C616 when a patient is re-admitted to the hospital for the same haematological issue after being discharged, and the attending physician requests a new consultation.
- Use C616 when a patient remains in the hospital for an extended period and a new, distinct clinical problem arises that requires a formal consultation request from the attending physician, provided another physician has rendered care in the interim.
Common Pitfalls
- Billing C616 without a new, written, and dated referral request from the attending physician will lead to automatic rejection or recovery upon audit.
- Using C616 for a follow-up visit where no other physician has provided care in the interim is a common error; such visits should be billed as subsequent hospital visits (e.g., C612) instead.
- Failing to document the specific 'interim care' provided by another physician (e.g., the hospitalist or primary attending) renders the repeat consultation status invalid.
Billing Tips
- Ensure the referring physician's name and billing number are explicitly recorded in your notes to satisfy the mandatory documentation requirements for the 'C' prefix.
- Unlike initial consultations (C615), C616 is not subject to the standard 12-month frequency limits, making it the correct code for complex, multi-admission haematology cases.
Effective: June 1, 2025
Consultations and Visits
Haematology (61)
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
A new written request by the referring physician, nurse practitioner or dental surgeon is required.
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 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 standard limits on consultation services (e.g., one service per two consecutive 12 month periods for the same diagnosis) do not apply to repeat consultations.
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