W646 – 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. This service has the same requirements as a consultation, including the need for a new written request by the referring physician, nurse practitioner, or dental surgeon. It is applicable for non-emergency in-patient services in settings such as Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, and Homes for the Aged. The consultant must provide a written report of their findings and recommendations back to the referring practitioner. Refer to through for full consultation requirements.
When to Use
- Use W646 when you are re-evaluating a patient for the same condition after another physician has provided care in the interim, specifically within a long-term care facility.
- Use this code when the initial consultation (W645) has already occurred and a new, distinct written referral is received for a follow-up assessment of the original problem.
Common Pitfalls
- Billing W646 without a new, formal written referral from the referring practitioner will result in a claim rejection or a downgrade to a lower-value assessment code.
- Attempting to bill W646 for emergency situations or in acute care settings will lead to audit flags, as this code is strictly for non-emergency long-term care institutional services.
- Confusing W646 with a standard follow-up visit; remember that W646 requires the same documentation rigor as an initial consultation, including a formal report back to the referrer.
Billing Tips
- Ensure your documentation explicitly references the 'interim care' provided by another physician to justify the 'repeat' status of the consultation.
- Always verify that the referral request includes the referring practitioner's billing number, as missing this detail is a common cause for administrative rejection.
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 practitioner, must be kept in the consulting physician's medical record (or on the common medical record in a hospital or long-term care institution).
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 the information relevant to the referral and specify the service(s) required.
The consultant must prepare a written report (including findings, opinions, and recommendations) for 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. It 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 is for non-emergency in-patients in a Long-Term Care Institution, which includes Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, and designated chronic or convalescent care beds in hospitals (excluding designated palliative care beds).
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