W056 – 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, 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. This service is provided in a Non-Emergency Long-Term Care In-Patient setting, which includes Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, and Homes for the Aged. It requires a new written request from a referring physician, nurse practitioner, or dental surgeon, and must meet all the documentation and service requirements of a standard consultation as outlined in the Schedule of Benefits. See pages - for full consultation requirements.
When to Use
- Use W056 when you are re-evaluating a patient for the same chronic condition in a long-term care setting after the primary care physician or another specialist has provided intervening care.
- Use this code when the patient's clinical status for a previously consulted condition has changed, necessitating a new formal written referral to justify a comprehensive re-assessment.
Common Pitfalls
- Billing W056 without a new, distinct written referral request from the referring physician, which is a mandatory requirement even for repeat consultations.
- Failing to document that another physician provided care in the interval between the initial consultation and the repeat service, which is a strict eligibility criterion.
- Using W056 for routine follow-up visits where no new referral was generated, as these should be billed as subsequent visits (e.g., W052) rather than consultations.
Billing Tips
- Ensure the referring physician's name and billing number are clearly documented in the patient's chart to satisfy the audit requirements for a valid referral.
- Always verify that the setting qualifies as a non-emergency long-term care in-patient facility, as W056 is specifically restricted to these environments and cannot be used for standard hospital acute care wards.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
A repeat consultation has the same requirements as a consultation including the requirement for a new written request by the referring physician, nurse practitioner or dental surgeon.
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, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
The request identifies the consultant by name, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
This service is for Non-Emergency Long-Term Care In-Patient Services. This includes 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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