W166 – Repeat Consultation
OHIP Neurology Code — Nephrology (16) · 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 including the requirement for a new written request by the referring physician, nurse practitioner or dental surgeon. This service applies to patients in chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged and designated chronic or convalescent care beds in hospitals other than patients in designated palliative care beds.
When to Use
- Use W166 when a patient in a nursing home or chronic care facility requires a reassessment for the same nephrological condition after an intervening period of care provided by the primary care physician.
- Use this code when the patient's clinical status has changed sufficiently to warrant a new formal consultation request from the referring physician, even if you have previously consulted on the same diagnosis.
Common Pitfalls
- Billing W166 without a new, distinct written referral request on file for the repeat encounter will lead to automatic rejection or clawbacks during audit.
- Attempting to use W166 for patients in acute care hospital beds is incorrect; it is strictly limited to chronic care, convalescent, nursing homes, or homes for the aged.
- Confusing W166 with a standard follow-up visit (A166); W166 requires a formal referral and report, whereas A166 does not.
Billing Tips
- Ensure your documentation explicitly references the intervening care provided by the referring physician to satisfy the 'repeat' criteria defined in the Schedule of Benefits.
- Always attach the appropriate age-based premium code to W166 if the patient qualifies, as these are specifically permitted for repeat consultations.
Effective: June 1, 2025
Consultations and Visits
Nephrology (16)
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
A new written request by the referring physician, nurse practitioner or dental surgeon is required and a copy must be kept in the consulting physician's medical record.
The consultant must prepare a written report (including findings, opinions, and recommendations) to the referring practitioner.
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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