1What Is the C036 OHIP Code?
What is C036?
C036 is specifically designed for a repeat consultation in the context of general surgery. It is used when a general surgeon is called back to evaluate an in-patient after a change in their condition, such as a rising white count or new peritoneal signs.
A repeat consultation must involve a new written request from the referring healthcare provider, ensuring that the consultation addresses the patient's evolving clinical needs. The complexity and specific requirements to bill this code mean it can occasionally be overlooked, particularly when follow-ups are perceived as routine monitoring rather than distinct, billable consultations.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | Varies by service | Higher complexity consultation specific to surgery. |
| C935 | Special surgical consultation | Varies by service | Equivalent to A935 but for settings where C-prefixed codes apply. |
| A035 | Consultation | Limited to once per two consecutive 12-month periods, barring exceptions. | Standard consultation in general surgery. |
| A036 | Repeat consultation | Same as C036 but for outpatient settings. | Repeat consultation outside hospital inpatient settings. |
| C036 | Repeat consultation | No frequency cap when valid documentation is provided. | Follow-up consultation for inpatients previously seen by the consultant. |
3Eligibility Requirements
Eligibility Requirements
To bill the C036 code for a repeat consultation in Ontario:
- New Written Request: Each repeat consultation requires a new written request from the referring physician, nurse practitioner, or dental surgeon.
- Written Request Retention: A copy of this request must be kept in the consulting physician's medical record unless the consultation occurs in a hospital, long-term care institution, or multi-specialty clinic where common medical records are maintained.
- Virtual Consultations: C036 can be billed as C036A for virtual consultations, but these must be conducted via video as telephone consults do not qualify.
4What Your Clinical Note Must Show
Ensure these elements are recorded:
- A new written request from the referring provider.
- Retention of the request in patient records unless in shared record settings.
5Weak vs. Strong Note Examples
The strong note includes detailed clinical observations and context for the follow-up, addressing the specific changes that necessitated the repeat consultation, demonstrating compliance with OHIP requirements.
Patient seen for follow-up consultation.
Discussed ongoing care.
Patient presented with new peritoneal signs.
Re-assessment confirmed indication for surgery due to worsening condition.
Consultation requested by Dr. Smith due to change in clinical status.
- Request for repeat consultation from referring physician documented.
- Detailed assessment and plan recorded.
