W266 – Repeat consultation - 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 for the same presenting problem, following care rendered to the patient by another physician in the interval between the initial consultation and the repeat consultation. It has the same requirements as a standard consultation, including a new written request from a referring physician, nurse practitioner, or dental surgeon. The consultant must perform an appropriate assessment and provide a written report of findings, opinions, and recommendations to the referring practitioner. This service is specifically for non-emergency situations in long-term care settings.
When to Use
- Use W266 when a specialist is re-engaged for a previously consulted issue after the patient has been managed by another physician, such as the attending LTC physician, for a period of time.
- Use W266 when the patient's clinical status for a chronic condition has changed significantly enough to warrant a new formal opinion, provided a new written referral is obtained.
Common Pitfalls
- Billing W266 without a new, distinct written referral request from the referring practitioner will result in an automatic rejection or clawback upon audit.
- Using W266 for routine follow-up visits where no new referral was requested; these should be billed as subsequent visits (e.g., W662) rather than a repeat consultation.
- Failing to document the 'intervening care' provided by another physician, which is a mandatory requirement to distinguish a repeat consultation from a standard follow-up.
Billing Tips
- Ensure the referral note explicitly states the reason for the new consultation request to satisfy the documentation requirement for a 'new' assessment.
- Always verify that the referring practitioner's name and billing number are clearly linked to the W266 claim to avoid administrative rejections.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
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.
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 and/or the specialty being consulted, 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.
A consultation includes the services necessary to enable the consultant to prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon.
The limits on the number of consultations per 12 or 24 month period do not apply to repeat consultations.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.