W086 – Repeat Consultation
OHIP Neurology Code — Plastic Surgery (08) · 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 consultation, as defined on of the Schedule, including the requirement for a new written request from a referring physician, nurse practitioner, or dental surgeon. The consultant is required to perform an assessment and prepare a written report (including findings, opinions, and recommendations) for the referring provider.
When to Use
- Use W086 when a patient returns for a follow-up on the same condition after they have been seen by their primary care provider or another specialist for that issue in the interim.
- Use W086 when a new referral request is generated for a previously consulted condition, specifically to address a change in status or a new clinical question requiring a formal specialist opinion.
Common Pitfalls
- Billing W086 without a new, distinct written referral request from the referring physician, which is a mandatory requirement for every repeat consultation.
- Confusing W086 with a follow-up assessment (A085); W086 requires a formal report back to the referring provider, whereas a standard follow-up does not.
- Failing to document that the patient received care from another physician in the interval between the initial consultation and the repeat consultation, which is a core definition of W086.
Billing Tips
- Ensure your clinical notes explicitly state the name of the physician who provided care in the interval to satisfy the definition of a repeat consultation.
- Always verify that the referral request for W086 is dated after the initial consultation to prove the 'repeat' nature of the service.
Effective: June 1, 2025
Consultations and Visits
Plastic Surgery (08)
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
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 facility with a common medical record, the written request may be on the common record.
The request must identify the consultant by name, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identify 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.
A written report including findings, opinions, and recommendations must be prepared and sent to the referring physician, nurse practitioner or dental surgeon.
Non-Emergency Long-Term Care In-Patient Services 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 General Preamble to .
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