W156 – Repeat Consultation
OHIP Neurology Code — Endocrinology & Metabolism (15) · 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. It has the same requirements as a full consultation, including a new written request from a referring physician, nurse practitioner, or dental surgeon. This service is for non-emergency in-patient services in settings such as chronic care hospitals, convalescent hospitals, nursing homes, and homes for the aged, as per and .
When to Use
- Use W156 when you have already provided an initial consultation (e.g., W150) for a chronic condition in a long-term care or convalescent facility and a new referral is required to address the same problem after intervening care by another physician.
- Use this code for non-emergency follow-up consultations in chronic care or nursing homes where the patient's condition has evolved, necessitating a formal re-evaluation and a new written referral.
Common Pitfalls
- Billing W156 without a new written referral request on file; unlike standard repeat visits, a formal request from the referring practitioner is mandatory for every W156 claim.
- Attempting to bill W156 in conjunction with special visit premiums; these are not eligible, and you must use the appropriate 'A' prefix assessment codes if a special visit premium is required.
- Confusing W156 with a standard repeat assessment; if there has been no intervening care by another physician, W156 will be rejected or downgraded to a lesser assessment fee.
Billing Tips
- Ensure the referring practitioner explicitly requests the repeat consultation in writing to satisfy GP16 requirements, as this is the most common audit trigger for this code.
- Always document the specific intervening care provided by another physician in the patient's chart to justify the 'repeat' status of the consultation over a standard follow-up visit.
Effective: June 1, 2025
Consultations and Visits
Endocrinology & Metabolism (15)
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. For long-term care institutions with common medical records, the request may be on the common record as per .
The written request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number as per .
The written request must set out the information relevant to the referral and specify the service(s) required as per .
The consultant must prepare and provide a written report with findings, opinions, and recommendations to the referring practitioner as per .
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