W036 – Repeat consultation - Non-Emergency Long-Term Care In-Patient Services
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A repeat consultation rendered by a general surgeon for a non-emergency in-patient in a long-term care facility, including Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, and Homes for the Aged. As per the General Preamble (), a repeat consultation is an additional consultation for the same presenting problem, following care rendered by another physician in the interval after the initial consultation. This service has the same requirements as a regular consultation (), including the need for a new written request from a referring physician, nurse practitioner, or dental surgeon.
When to Use
- Use W036 when a general surgeon provides a second consultation for a previously assessed chronic condition in a long-term care facility, provided another physician has managed the patient in the interim.
- Use this code when the patient's clinical status has changed significantly enough to warrant a formal re-evaluation by the surgeon, following a referral from the primary care provider or attending nurse practitioner.
Common Pitfalls
- Billing W036 for routine follow-up visits where no new referral request exists; this will be downgraded to a lower-value assessment code upon audit.
- Failing to document that another physician provided care in the interval between the initial consultation and this repeat consultation, which is a mandatory requirement under GP19.
- Using W036 for emergency situations in long-term care; these must be billed using the appropriate 'A' prefix emergency visit codes and associated premiums.
Billing Tips
- Ensure the referring practitioner's name and billing number are clearly linked to the specific written request in your chart to satisfy the requirements of GP16.
- Always generate and send a formal consultation report to the referring provider, as the absence of this report will invalidate the consultation claim during a Ministry review.
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 is required ().
A copy of the written request for the consultation must be kept in the consulting physician's medical record. In a long-term care institution with a common medical record, the written request may be contained on the common 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 consultant must prepare a written report including findings, opinions, and recommendations to the referring practitioner ().
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