W306 – 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, 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 specific service is for non-emergency in-patients in a Chronic Care Hospital, Convalescent Hospital, Nursing Home, Home for the Aged, or designated chronic or convalescent care beds in hospitals, other than patients in designated palliative care beds. Where indicated, this service includes biopsy of cervix, collection of cervical cancer screening specimen(s), and examination of trichomonas suspension.
When to Use
- Use W306 when you are re-evaluating a long-term care patient for the same presenting problem after the primary care physician or another specialist has provided active management in the interim.
- Use this code for a planned follow-up consultation in a nursing home or chronic care facility that requires a new written referral request to address a specific change in the patient's status regarding the original diagnosis.
Common Pitfalls
- Billing W306 without a new, distinct written referral request on file is a primary audit risk; a standing order or the original referral for W305 does not satisfy the requirement for a repeat consultation.
- Attempting to bill W306 when no other physician has provided care in the interval between the initial consultation and the current visit, which fails the mandatory 'intervening care' requirement.
- Billing for a cervical biopsy or screening specimen collection separately; these procedures are bundled into W306 and are not eligible for additional fee-for-service claims.
Billing Tips
- Ensure the referring physician's name and billing number are clearly documented in the patient's chart to substantiate the validity of the repeat referral requirement.
- If the patient is under 16 years of age, verify that the appropriate age premium is applied, as these are specifically eligible for W306.
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.
Includes (where indicated) biopsy of cervix, collection of cervical cancer screening specimen(s), examination of trichomonas suspension.
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