W196 – 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. This service is performed in a non-emergency capacity for an in-patient of a long-term care institution (e.g., chronic care hospital, nursing home, home for the aged). A repeat consultation has the same requirements as a consultation, including the requirement for a new written request from a referring physician, nurse practitioner, or dental surgeon.
When to Use
- Use W196 when you are re-evaluating a long-term care patient for the same condition after a primary care physician or another specialist has provided intervening care.
- Use this code instead of a standard visit code (e.g., W010) when the clinical complexity warrants a formal consultation report and a new written request from the referring practitioner is obtained.
Common Pitfalls
- Billing W196 without a new, distinct written referral request on file, which is a mandatory requirement for every repeat consultation.
- Failing to document that another physician provided care in the interval between the initial consultation and this repeat visit, which is a strict eligibility criterion.
- Using W196 for patients in acute care hospitals; this code is strictly reserved for patients in long-term care institutions like nursing homes or chronic care facilities.
Billing Tips
- Ensure your documentation explicitly names the referring practitioner and the specific intervening care provided to satisfy audit requirements for the 'repeat' status.
- Always verify that the referral request specifies the service required, as a generic 'follow-up' note may be insufficient to support the consultation fee over a standard visit code.
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 repeat consultation, signed by the referring practitioner, must be kept in the consultant's medical record (unless in a facility with a common medical record).
The request must identify the consultant, referring practitioner (with billing number), and patient (with health number).
The request must set out relevant information and specify the service(s) required.
A written report (including findings, opinions, and recommendations) must be prepared and sent 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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