1What Is the C186 OHIP Code?
C186: Definition and Clinical Context
The OHIP billing code C186 is designated for repeat consultations within the Neurology specialty. This code is applicable when a neurologist re-evaluates a hospital in-patient due to changes in the patient's condition, such as new neurological deficits, persistent seizures, or unexpected imaging results. This service must be initiated by a written request from the referring physician, nurse practitioner, or dental surgeon.
Physicians often miss this detail: a repeat consultation necessitates a new written request. Self-initiated follow-ups are classified as subsequent visits and do not qualify for the C186 billing.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A180 | Special neurology consultation | No specific limit, refers to complex consultations | Covers consultations of a specialized nature in neurology. |
| A185 | Consultation | No specific limit | Standard neurology consultation. |
| A186 | Repeat consultation | Excluded from GP17 limits | Similar repeat consultation for neurology. |
| A385 | Limited consultation | No specific limit | Covers limited scope consultations in neurology. |
3Eligibility Requirements
Eligibility Requirements for C186
- Written Request Requirement: C186 requires a new written request from a referring physician, nurse practitioner, or dental surgeon each time the service is rendered.
- Exclusion from Consultation Limits: This code is excluded from the frequency limits outlined in GP17, meaning it can be billed beyond typical consultation limits if each condition is met.
- Virtual Care Eligibility: C186 can be provided as a virtual consultation if delivered via video (billed as C186A). Telephone consultations are ineligible.
- Timing: It may be claimed only 6 months after a Periodic health visit as per the Nursing Homes Act.
4What Your Clinical Note Must Show
Ensure the following documentation is complete and accurate:
- A new written request from a referring physician, nurse practitioner, or dental surgeon.
- Thorough documentation of the patient's change in condition necessitating the repeat consultation.
- Indicate virtual consultation format if applicable, specifying the use of video.
5Weak vs. Strong Note Examples
The strong note clearly outlines the patient's condition changes and the new referral request, meeting the billing criteria for C186.
Repeat consult for John's seizure issue. Checked again.
A new episodic seizure activity noted in the patient, **John Doe**, admitted on 2023-09-12. MRI results show unexpected changes.
A repeat neurology consultation requested by Dr. Smith due to progression in symptomatology.
- Documented the change in clinical condition.
- Detailed the new request for repeat consultation.
