C626 – Repeat Consultation
OHIP Surgical Procedures Code — Clinical Immunology (62) · Schedule of Benefits
A repeat consultation is an additional consultation rendered by the same consultant for 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. As a 'C' prefix code, this service is specifically for non-emergency hospital in-patients (Source: :). A repeat consultation has the same requirements as a full consultation, including a new written request from a referring physician, nurse practitioner, or dental surgeon (Source: :). The service includes all specific elements of an assessment as outlined in :, such as a direct physical encounter, history taking, physical examination, and discussion with the patient. The consultant must prepare a written report for the referring practitioner, and a copy of the referral request must be maintained in the patient's medical record (Source: :). Repeat consultations are an exception to the standard consultation limits outlined in :.
When to Use
- Use C626 when you are providing a repeat consultation for a previously assessed inpatient problem after a different physician has intervened in the patient's care.
- Use C626 when the clinical complexity of the patient's condition necessitates a formal re-evaluation that meets all consultation requirements, rather than a standard subsequent visit (e.g., C625).
Common Pitfalls
- Billing C626 without a new, distinct written referral request from a physician, nurse practitioner, or dental surgeon, which is mandatory for every repeat consultation.
- Attempting to claim C626 in conjunction with special visit premiums, which are strictly prohibited for this code as it is a non-emergency hospital service.
- Failing to document a formal report back to the referring practitioner, which is a core requirement that distinguishes a consultation from a standard visit.
Billing Tips
- Ensure the referring practitioner's billing number is clearly recorded on the referral request to avoid administrative rejections during audit.
- If the patient's condition has not changed or no new intervention by another physician has occurred, bill a subsequent visit (e.g., C625) instead of C626 to avoid recovery of funds.
Effective: June 1, 2025
Consultations and Visits
Clinical Immunology (62)
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
A copy of the new written request for the repeat consultation, signed by the referring practitioner, must be kept in the consulting physician's medical record. As this is a hospital service, the written request may be contained on the common medical record. (Source: :)
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. (Source: :)
The written request must set out information relevant to the referral and specify the service(s) required. (Source: :)
The consultant must prepare a written report (including findings, opinions, and recommendations) to the referring practitioner. (Source: :)
For Services not listed, refer to Internal Medicine Section.
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