W226 – Repeat consultation - Genetics - Non-Emergency Long-Term Care In-Patient Services
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 applies when rendered by a Genetics specialist in a non-emergency long-term care in-patient setting.
When to Use
- Use W226 when you are providing a repeat consultation for a patient in a long-term care facility after the patient has been managed by another physician since your initial A226 or C226 consultation.
- Use this code when a new, specific clinical question arises regarding the same genetic condition that requires a formal written referral from the attending physician or nurse practitioner.
Common Pitfalls
- Billing W226 when you have already claimed K222 for the same patient, as the Ministry will reject the consultation fee as nil.
- Failing to secure a new, distinct written referral request for the repeat consultation, which is a mandatory requirement for all 'repeat' consultation codes.
- Using W226 for routine follow-up visits; this code is strictly for a formal repeat consultation triggered by a new referral, not for ongoing management.
Billing Tips
- Ensure the referring physician's name and billing number are clearly documented in the patient's chart to satisfy the audit requirement for a valid referral source.
- Verify that the patient's age is documented accurately to apply the appropriate age premium, as these are automatically calculated based on the patient's date of birth.
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 in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
The request identifies the consultant by name, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
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