W356 – Repeat consultation - Urology - 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 may include physical examination pertaining to the genito-urinary tract and when necessary such procedures as urethral calibration, catheterization and prostatic fluid examination, but not to include endoscopic examination.
When to Use
- Use W356 when a patient has been seen by another physician (e.g., a hospitalist or GP) for the same urological issue since your initial consultation, and you are re-evaluating the patient at the request of that physician.
- Use this code for a follow-up assessment in a long-term care setting where a new written referral has been generated to address the original presenting problem after an interval of care by another provider.
Common Pitfalls
- Billing W356 without a new, distinct written request from the referring practitioner will result in a downgrade to a lower-value assessment code.
- Attempting to bill special visit premiums with W356 will result in rejection; for non-elective, urgent visits, use an A-prefix code from the General Listings instead.
- Billing for procedures like catheterization or urethral calibration separately is a common audit trigger, as these are considered bundled into the W356 fee.
Billing Tips
- Ensure your documentation explicitly references the intervening care provided by another physician to satisfy the specific criteria for a 'repeat' consultation.
- If you are performing an endoscopic examination during the visit, you cannot use W356; you must bill the appropriate assessment code and the endoscopic procedure code separately.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
A repeat consultation requires a new written request from the referring practitioner.
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, unless in a facility with a common medical record where the request may be contained therein.
The written request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number.
The written request must set out relevant information and specify the service(s) required.
The consultant must prepare a written report (including findings, opinions, and recommendations) for the referring practitioner.
May include physical examination pertaining to the genito-urinary tract and when necessary such procedures as urethral calibration, catheterization and prostatic fluid examination, but not to include endoscopic examination.
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