C636 – Repeat Consultation
OHIP Surgical Procedures Code — Nuclear Medicine (63) · 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 by the referring physician, nurse practitioner, or dental surgeon. This service is rendered by a specialist in Nuclear Medicine for a non-emergency hospital in-patient, as indicated by the 'C' prefix. It includes all the specific elements of an assessment as described on , such as a history and examination, and the preparation of a written report to the referring practitioner. If the requirements for a consultation are not met, the amount payable will be adjusted to a lesser assessment fee.
When to Use
- Use C636 when you have already provided an initial consultation (C635) for a specific condition, and the patient has since been managed by the referring physician or another practitioner before requiring your specialist input again.
- Use C636 when a new, distinct clinical question arises regarding the same presenting problem that necessitates a formal re-evaluation and a new written request from the referring physician.
Common Pitfalls
- Billing C636 without a new, formal written request from the referring physician will lead to a rejection or a downgrade to a lower-valued assessment code during audit.
- Attempting to bill C636 for routine follow-up visits where no intervening care by another physician occurred; these should be billed as subsequent hospital visits (C632) instead.
- Submitting C636 with special visit premiums (e.g., K963) will trigger a rejection, as 'C' prefix codes are strictly ineligible for these premiums.
Billing Tips
- Ensure the referring physician's new written request explicitly references the need for a repeat consultation to satisfy the documentation requirements for C636.
- If the patient's condition has changed significantly or a new diagnosis is suspected, ensure your written report clearly distinguishes the findings from the initial C635 consultation to justify the repeat service.
Effective: June 1, 2025
Consultations and Visits
Nuclear Medicine (63)
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
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.
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 consultant must prepare a written report including findings, opinions, and recommendations to the referring practitioner.
This code applies to services rendered to non-emergency hospital in-patients.
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