W066 – 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 requires a new written request from the referring practitioner and is applicable to non-emergency patients in chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent care beds.
When to Use
- Use W066 when you are re-evaluating a patient for the same chronic condition after a period where the patient was managed by the primary care provider or another specialist.
- Use this code for a formal reassessment in a nursing home or chronic care bed when a new written referral is obtained following a significant change in the patient's status regarding a previously consulted problem.
Common Pitfalls
- Billing W066 without a new, distinct written referral request from the referring practitioner will lead to automatic rejection or clawbacks during audits.
- Attempting to bill W066 for ongoing management or follow-up visits where no new referral was generated; this code is strictly for a 'repeat consultation' event, not routine care.
- Submitting W066 for patients in acute care or palliative care beds, as the code is strictly restricted to chronic, convalescent, or nursing home settings.
Billing Tips
- Ensure the referring physician's name and billing number are clearly documented in your chart to satisfy the requirement for a valid written request.
- If you are providing ongoing management for the same diagnosis, do not use W066; instead, bill the appropriate subsequent visit code (e.g., W062 or W063) to avoid billing violations.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
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. In a long-term care institution where common medical records are maintained, 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.
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