W046 – Repeat consultation - Non-Emergency Long-Term Care In-Patient Services
OHIP Neurology Code — CONSULTATIONS AND VISITS · 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. This service has the same requirements as a regular consultation, including a new written request. This specific code applies when the service is rendered by a Neurosurgeon to a patient in a non-emergency situation within a long-term care institution, such as a Chronic Care Hospital, Convalescent Hospital, Nursing Home, or Home for the Aged.
When to Use
- Use W046 when a neurosurgeon is requested to re-evaluate a patient in a long-term care facility for a previously assessed condition after the patient has been managed by another physician (e.g., the attending GP or NP) in the interim.
- Use this code when the patient's clinical status has changed or a new management plan is required for the same presenting problem, provided a new written referral is obtained.
Common Pitfalls
- Billing W046 without a new, distinct written request from the referring practitioner will result in a rejection or clawback during audit.
- Using W046 for a routine follow-up visit where no intervening care by another physician occurred; this should be billed as a subsequent visit rather than a repeat consultation.
- Confusing W046 with W045; ensure the patient is in a qualifying long-term care setting, as W046 is specific to non-emergency institutional care.
Billing Tips
- Ensure the written referral clearly documents the 'interval of care' by another physician to satisfy the specific requirement for a repeat consultation.
- Always verify that the referring practitioner's billing number is included in your records, as this is a mandatory field for audit compliance.
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 for each repeat consultation.
A copy of the written request for the consultation, signed by the referring practitioner, must be kept in the consulting physician's medical record (or on the common medical record in a hospital or long-term care institution).
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.
This service applies to patients in chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged, designated chronic or convalescent care beds in hospitals and nursing homes or homes for the aged, other than patients in designated palliative care beds.
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see to .
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