W186 – Repeat consultation
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. 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 (W186) is specifically for a neurologist providing non-emergency care to a patient in a long-term care setting. Refer to for the general definition of a repeat consultation.
When to Use
- Use W186 when a neurologist provides a repeat consultation in a long-term care facility after the patient has been seen by another physician (e.g., the primary care provider) for the same neurological issue since the initial consultation.
- Use this code specifically for non-emergency neurological assessments in long-term care where a new written referral request has been generated by the referring practitioner.
Common Pitfalls
- Billing W186 without a new, distinct written referral request from the referring physician or nurse practitioner will result in a rejection or clawback during audit.
- Attempting to bill W186 alongside Special Visit Premiums is prohibited; use an A-prefix code (e.g., A186) if a premium is required for a non-elective visit.
- Confusing W186 with a routine follow-up visit; W186 requires the specific 'repeat consultation' criteria, including the interval of care by another physician and a formal report back to the referrer.
Billing Tips
- Ensure the written referral request explicitly states the reason for the repeat consultation to satisfy the documentation requirements for a consultation-level service.
- W186 is compatible with the monthly management fee W010, as the specialist is not the Most Responsible Physician (MRP) in that context.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
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, except where common medical records are maintained ().
The request must identify the consultant by name, the referring practitioner by name and billing number, and 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 for the referring practitioner ().
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