W466 – Repeat Consultation
OHIP Neurology Code — Infectious Disease (46) · Schedule of Benefits
A repeat consultation is an additional consultation rendered by the same consultant for the same presenting problem. This service is provided following care rendered to the patient by another physician in the interval between the initial consultation and this repeat consultation. A repeat consultation has the same requirements as an initial consultation, including the need for a new written request from the referring physician, nurse practitioner, or dental surgeon. This specific fee code applies when the service is rendered in a Non-Emergency Long-Term Care In-Patient Services setting, which includes Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, and Homes for the Aged.
When to Use
- Use W466 when you have previously provided a consultation (W465) for the same clinical problem, and the patient has since been managed by another physician (e.g., the primary care provider) before returning to you for further expert opinion.
- Use this code specifically for patients in long-term care settings, such as nursing homes or chronic care hospitals, where the patient's condition has evolved or requires a new management strategy after an interval of care by the facility physician.
Common Pitfalls
- Billing W466 without a new, distinct written request from the referring physician or nurse practitioner will lead to a rejection or audit recovery; a verbal request is insufficient.
- Attempting to bill W466 for a routine follow-up visit where no intervening care by another physician occurred; this should be billed as a subsequent visit (e.g., W460) rather than a repeat consultation.
- Failing to provide a formal written report back to the referring physician after the repeat consultation, which is a mandatory requirement to qualify for the consultation fee.
Billing Tips
- Ensure the referral request explicitly states the reason for the repeat consultation to distinguish it from a standard follow-up and justify the 'consultation' level of service.
- Verify that the patient has received care from another physician in the interval between your initial consultation and this repeat visit to satisfy the specific definition of W466.
Effective: June 1, 2025
Consultations and Visits
Infectious Disease (46)
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. In a long-term care institution where common medical records are maintained, 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 must set out the information relevant to the referral and specifies the service(s) required.
A written report including findings, opinions, and recommendations must be prepared and provided to the referring practitioner.
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.
The standard limit of one consultation per two consecutive 12-month periods for the same diagnosis does not apply to repeat consultations.
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