W236 – Repeat consultation - non-emergency long-term care in-patient services
OHIP Neurology Code — INTERNAL AND OCCUPATIONAL MEDICINE (13) · 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: - A written request from a referring physician, nurse practitioner, or dental surgeon. - A general, specific, or medical specific assessment, including a review of all relevant data. - Preparation of a written report (including findings, opinions, and recommendations) to the referring practitioner.
When to Use
- Use W236 when you are re-evaluating a patient for the same condition after a primary care physician or another specialist has managed the patient in the interim.
- Use this code for a follow-up assessment in a long-term care facility when the patient's clinical status has significantly changed, necessitating a new written referral request.
Common Pitfalls
- Billing W236 without a new, distinct written referral request from the referring practitioner will lead to automatic rejection or audit recovery.
- Attempting to bill W236 for routine follow-up visits where no intervening care by another physician occurred; these should be billed as subsequent visits (e.g., W765) instead.
- Failing to document the specific 'intervening care' provided by another physician, which is a mandatory requirement to distinguish a repeat consultation from a standard visit.
Billing Tips
- Ensure the referring physician's name and billing number are clearly linked to the new request in your chart to satisfy the audit requirements for a repeat consultation.
- Always generate a formal written report to the referring practitioner following the W236 assessment, as the absence of this report invalidates the consultation claim.
Effective: June 1, 2025
A. Consultations and Visits
INTERNAL AND OCCUPATIONAL MEDICINE (13)
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.
The consultant must prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon.
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