W446 – 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 following the initial consultation but preceding the repeat consultation, as defined in . This service has the same requirements as a consultation, including a written request from a referring physician, nurse practitioner, or dental surgeon, and the preparation of a written report to the referring provider. This specific 'W' prefix code applies to non-emergency services rendered by a medical oncologist in a long-term care institution, which includes chronic care hospitals, convalescent hospitals, nursing homes, and homes for the aged, as outlined on and . Repeat consultations are an exception to the standard consultation limit of one service per two consecutive 12-month periods for the same diagnosis (see ). For emergency calls or special visits, 'A' prefix codes and special visit premiums must be used instead.
When to Use
- Use W446 when a medical oncologist provides a repeat consultation for a patient in a long-term care facility after the patient has been managed by another physician since the initial W445 consultation.
- Select this code when the patient presents with the same diagnosis as the initial consultation, but a new clinical assessment is required due to a significant change in status or a request for a new opinion.
Common Pitfalls
- Billing W446 without a new, distinct written request from the referring provider, which is a mandatory requirement for every repeat consultation.
- Submitting W446 when the patient has not been seen by another physician in the interim, which fails the definition of a 'repeat' consultation and risks a downgrade to a subsequent visit code.
- Failing to document a formal report back to the referring provider, as the absence of this report will trigger a rejection or audit recovery.
Billing Tips
- Ensure the referring provider's name and billing number are clearly linked to the new referral request in your records to satisfy the GP19 requirements.
- Verify that the facility qualifies as a long-term care institution under A127/GP12 to avoid rejection for services that should have been billed under standard hospital consultation codes.
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. In a long-term care institution with common medical records, the written request may be on the common record.
The request must identify the consultant by name, the referring provider by name and billing number, and the patient by name and health number.
The written request must set out the information relevant to the referral and specify the service(s) required.
The consultant must prepare a written report (including findings, opinions, and recommendations) to the referring provider.
Patient age 17 or older
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