1What Is the A036 OHIP Code?
A repeat consultation under OHIP billing code A036 is an additional consultation provided by a general surgeon for the same presenting problem after care has been given by another physician in the interim. This often occurs in settings such as an office or outpatient clinic when a patient is referred back after further imaging, failed conservative management, or changed symptoms have prompted reconsideration for surgery.
Misunderstandings about what constitutes a "repeat" consultation can lead to billing errors. It is crucial to have a new written request from a referring physician, nurse practitioner, or dental surgeon, as this ensures the service is properly classified under the A036 code rather than being mistakenly billed as a general assessment.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | As specified per case | Higher complexity consultations involving special surgical scenarios. |
| C935 | Special surgical consultation | As specified per case | Equivalent of A935 for inpatient settings. |
| A035 | Consultation | Typically limited to one per two consecutive 12-month periods for the same diagnosis. | Standard consultation service in general surgery. |
| C035 | Consultation | Typically limited to one per two consecutive 12-month periods for the same diagnosis. | Equivalent of A035 for inpatient settings. |
3Eligibility Requirements
Eligibility Requirements for A036
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Written Request: Each repeat consultation requires a new written request signed by the referring physician, nurse practitioner, or dental surgeon. This request must be retained in the consulting physician's medical record unless the consultation occurs in institutions where common records are maintained.
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Service Exclusions: The A036 service is not included in the standard consultation frequency limits outlined in GP17. It must involve a scenario where another physician has provided care for the same issue since the last consultation.
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Virtual Care: A036 can be billed as A036A if delivered via eligible video methods. Telephone consultations are not covered under this service.
Failure to meet these requirements could result in the fee being adjusted to that of a general or specific assessment.
4What Your Clinical Note Must Show
Ensure the following documentation is maintained:
- A new written request for the consultation signed by the appropriate referring parties.
- Records must be kept in the consulting surgeon's file or within the common medical records where applicable.
5Weak vs. Strong Note Examples
The strong note provides detailed context around why the repeat consultation was necessary, references interim management by another physician, and documents the decision-making process supported by a new written request.
Patient seen for repeat consultation. Symptoms persisted. Will consider surgical options.
Patient presented for a repeat consultation following imaging that showed progression. Original symptoms of X have persisted despite conservative management as planned by Dr. Y. Another surgeon was engaged in interim management.
- Decision to revisit the surgical option initiated.
- New written referral request from Dr. Y on file.
