1What Is the C246 OHIP Code?
The C246 billing code is used for repeat consultations by otolaryngology (ENT) specialists in Ontario. This code applies when an ENT surgeon is asked to reassess a patient with the same presenting problem, initially seen by another physician. Repeat consultations are common in hospital in-patient settings, where a change in patient condition or new test results necessitate further specialist evaluation.
A typical scenario might involve an ENT specialist reassessing a patient admitted for a recurrent case of epistaxis or evaluating new developments from imaging of a deep neck infection. As such, it differs from an initial consultation and does not fall under standard frequency limits.
This code is often overlooked due to a misunderstanding of its eligibility criteria, especially regarding new referrals and the necessity of all documentation being in order at each stage.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | Unspecified in document | $194.65 for otolaryngology-specific special surgical consultations. |
| C935 | Special surgical consultation | Unspecified in document | $194.65 for otolaryngology-specific special surgical consultations, same service as A935. |
| A245 | Consultation | Unspecified in document | $92.70 for initial otolaryngology consultations. |
| A246 | Repeat consultation | Same as C246 but outside hospital in-patient settings | $53.65 for repeat consultations delivered outside hospital settings. |
3Eligibility Requirements
To be eligible for billing code C246 under OHIP, the following criteria must be met:
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Written Request: A new written request from the referring physician, nurse practitioner, or dental surgeon must be provided for each repeat consultation. This request should be retained in the medical record of the consulting ENT specialist, unless the consultation occurs in an institution maintaining common medical records.
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Virtual Consultations: C246 can be billed as C246A if delivered via video. Telephone consultations do not qualify under this classification.
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Specific Contexts: The repeat consultation should follow care previously rendered by another physician and must address the same clinical issue as initially diagnosed to qualify.
4What Your Clinical Note Must Show
Ensure the following documentation is complete for each repeat consultation billed under C246:
- Retain a copy of the written consultation request signed by the referring physician, nurse practitioner, or dental surgeon.
- Document the clinical reason for the repeat consultation in the patient's medical records.
- For virtual consultations, ensure that video was the method of communication and document this in the patient's file.
5Weak vs. Strong Note Examples
The strong note provides comprehensive details and context for the reassessment, documenting both the urgent clinical changes and a clear reference to the formal referral, aligning closely with OHIP billing requirements.
Reassessed patient post-operation. No new issues reported. Follow-up scheduled.
Patient reassessed due to recurrent epistaxis, initially resolved within 12 hours post initial operation. Imaging conducted one week post-op indicated resurgence, thus requiring repeat consultation as per Dr. Smith's referral, dated Sept 15, 2023. Hemostasis evaluated and new care plan implemented based on updated imaging results.
- Detailed clinical justification for the repeat consultation.
- Date and specifics of the new referral.
- Reference to updated diagnostic tools or results prompting the reassessment.
