1What Is the C076 OHIP Code?
The C076 billing code is used for repeat consultations in the field of geriatrics, typically conducted in a non-emergency hospital in-patient setting. A repeat consultation is defined as a follow-up consultation by the same geriatric consultant, focusing on the same presenting problem, after an interval of intermediate care by another physician. In the geriatric specialty, repeat consultations often occur when a hospital ward team re-refers an elderly patient already seen by the geriatric service due to a new episode of delirium or a fall.
Repeat consultations ensure the continuity of specialty care for complex geriatric patients, allowing for the re-assessment of evolving clinical scenarios. Despite the vital role this service plays in patient care, it's commonly missed in billing due to oversight in securing the necessary new referral documentation or misinterpreting the repeat consultation criteria.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A070 | Consultation in association with special visit | As needed | Applicable for consultations with special visits to hospital in-patients or emergency departments. |
| A075 | Consultation | 1 per 12-month period | Standard geriatric consultation. |
| A076 | Repeat consultation | As needed | Equivalent to C076 but for outpatient settings. |
| A375 | Limited consultation | As needed | For less complex consultations in geriatrics. |
3Eligibility Requirements
To bill under the C076 code for a repeat consultation in geriatrics, several eligibility requirements must be met:
- A new written request for the consultation must be provided and signed by the referring physician, nurse practitioner, or dental surgeon. This documentation must be maintained in the consulting physician's medical record unless the consultation occurs within a facility where common medical records are maintained.
- Repeat consultations are explicitly excluded from the general consultation frequency limits, but each requires a new written request.
- C076 can only be rendered in a non-emergency hospital in-patient setting and is eligible for virtual service when conducted via video.
- If the required documentation is not maintained, the payment defaults to a lower assessment fee.
4What Your Clinical Note Must Show
To ensure accurate billing of C076, the following documentation is essential:
- A new written request for repeat consultation signed by the referring clinician.
- The written request must be stored in the medical record unless in a common medical records facility.
- Ensure the consultation is for the same presenting problem as the initial consultation.
5Weak vs. Strong Note Examples
The strong note provides detailed context, includes the source of the referral, and outlines specific clinical actions taken, ensuring compliance with billing documentation requirements.
Consulted on patient due to fall. Referral noted.
Conducted repeat consultation for Mr. Smith, following a fall in hospital. This is a revisit concerning previous delirium issues.
Referred by Dr. Green on 3/2/2023, request attached to patient file.
- New symptoms assessed: increased confusion post-admission.
- Adjusted medication regimen to address recent changes in patient's condition.
