1What Is the C066 OHIP Code?
What is the C066 OHIP Billing Code?
C066 is a billing code used by orthopedic surgeons in Ontario for repeat consultations with hospital in-patients. These consultations occur after the initial consultation and often involve the reassessment of the patient in light of new diagnostic information, such as imaging results or after attempts at non-surgical management like traction.
Because repeat consultations require a fresh written request from a referring physician, nurse practitioner, or dental surgeon, they are excluded from the usual consultation frequency limits. It’s important for billing physicians to ensure all requirements are met, as missing documentation can result in adjustments to lesser assessment fees.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | No specific limits noted | Orthopaedic surgery related consultations. |
| C935 | Special surgical consultation | No specific limits noted | Orthopaedic surgery related consultations for in-patients. |
| A065 | Consultation | Limited to one per two consecutive 12 month periods except where exceptions apply. | Initial consultation under Orthopaedic Surgery (06). |
| A066 | Repeat consultation | Same rules as C066 but out-patient equivalent. | For consultations in out-patient settings. |
3Eligibility Requirements
Eligibility Requirements for C066 Billing
To be eligible for C066 billing under OHIP in Ontario, the following criteria must be met:
- A new written request must be received for each repeat consultation and this must be kept in the patient's medical record unless the consultation occurs in a hospital, long-term care facility or multi-specialty clinic where common medical records are maintained.
- The repeat consultation should address the same presenting problem as the initial consultation, occurring after another physician has provided care in the interim.
- C066 consultations are excluded from the frequency limits but each one must be justified by a new clinical request.
- Virtual consultations are only eligible under C066 if provided via video, not telephone.
4What Your Clinical Note Must Show
Ensure the following are documented and maintained in the patient's medical record:
- A new written request from the referring healthcare provider for each repeat consultation.
- Documentation confirming the repeat consultation addresses the same presenting problem.
- Clinical notes reflecting the assessment processes and medical decision making.
5Weak vs. Strong Note Examples
The strong note succeeds because it links the repeat consultation directly to new clinical information and fulfills documentation requirements, whereas the weak note lacks specifics and justification.
Patient seen again for follow-up. No new information. Consultation performed as per standard practice.
Following recent imaging results, patient reassessed during admission for previous femoral fracture. Imaging shows significant callous formation necessitating orthopedic reassessment of treatment plan. Consultation undertaken on basis of new CT evidence sent by Dr. Smith.
- New imaging assessments affecting treatment.
- Reason for reassessment well documented.
- Request details from Dr. Smith included.
