1What Is the C086 OHIP Code?
C086 is an OHIP billing code designated for repeat consultations specifically within the field of plastic surgery in Ontario, Canada. This billing code is applicable when a plastic surgeon reassesses a hospital in-patient after another specialist's intervention or due to a change in the patient's condition, such as wound deterioration requiring a change in the reconstruction plan.
Unlike initial consultations, repeat consultations under this code necessitate a written request to justify the revisit of the same presenting problem. Plastic surgeons often encounter situations where they need to reassess a patient post-intervention by another team or to revise a care plan based on new clinical findings or complications.
Missing this billing opportunity can occur if the documentation of the separate care provided by another physician isn't clear, leading to non-compliance with the repeat consultation criteria.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | Unspecified | Special surgical consultations within Plastic Surgery. |
| C935 | Special surgical consultation | Unspecified | Special surgical consultations specific to in-patient cases. |
| A085 | Consultation | Unspecified | Initial consultation in the Plastic Surgery listing. |
| A086 | Repeat consultation | Requirements align with C086 but for out-patient settings. | Repeat consultations for non-hospital inpatients. |
3Eligibility Requirements
To be eligible for billing under C086, the following requirements must be met:
- New Written Request: Each repeat consultation must be requested in writing by a referring physician, nurse practitioner, or dental surgeon. This request document should be retained in the patient's medical record.
- Hospital In-patient Setting: Typically applicable to a patient admitted as an in-patient where the initial consultation had already occurred, and additional concerns have arisen requiring reassessment.
- Exclusions and Frequency: Repeat consultations are not bound by the general consultation frequency limitations outlined in GP17. However, they must be preceded by care rendered by another physician for the same presenting problem.
Please note that if these requirements are not met, payment for a repeat consultation will be reduced to the level of a general or specific assessment fee.
4What Your Clinical Note Must Show
The following records should be maintained to support the billing of C086:
- A written request for consultation signed by the referring physician, nurse practitioner, or dental surgeon.
- A detailed medical record of the consultation, including the requester, reason for repeat consultation, and summarized clinical findings.
- Documentation of prior care rendered by another physician that correlates with the clinical need for reassessment.
5Weak vs. Strong Note Examples
The strong note succeeds by clearly recording the referring physician's request and detailing the medical reason for the reassessment, fulfilling documentation requirements.
Patient presented for reassessment after surgery. No new documentation from a referring physician.
The patient presented with a deteriorating wound after initial plastic surgery consultation. Referred by Dr. Smith for reassessment to evaluate new surgical intervention needs.
- Referral request from Dr. Smith received (dated).
- Assessment details: wound deterioration noted with treatment options revised based on current examination.
