1What Is the C266 OHIP Code?
What is C266?
C266 is an OHIP billing code used for repeat consultations in a paediatric hospital setting. This code applies specifically when a paediatrician is asked to reassess an in-patient they have previously seen, following a significant change in the patient's condition. A key requirement for billing C266 is a new written request from a referring physician, nurse practitioner, or dental surgeon. This ensures the repeat consultation is medically justified.
Paediatricians often encounter cases where a child's condition evolves during their hospital stay, necessitating a second evaluation. Understanding when to appropriately bill C266 can be challenging, particularly ensuring all documentation criteria are met, which can lead to missed billing opportunities.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A260 | Special paediatric consultation | As requested per patient need | Used for complex or special paediatric consultations, reflecting higher complexity or intensity of service. |
| A265 | Consultation | As requested per patient need | Standard initial consultation provided in a paediatric setting. |
| A266 | Repeat consultation | Exempt from consultation limits; new written request required | Equivalent service to C266, rendered outside the hospital in-patient environment. |
| A565 | Limited consultation | As requested per patient need | Covers less comprehensive consultations in a paediatric setting. |
3Eligibility Requirements
Eligibility Requirements
To bill for C266, the following criteria must be satisfied:
- The service is a repeat consultation on a hospital in-patient paediatric case.
- A new written request from the referring physician, nurse practitioner, or dental surgeon is mandatory.
- It can be rendered virtually, but only via video, billed as C266A. Telephone consultations do not qualify.
- C266 should only be used when the patient’s clinical condition has changed significantly, prompting the repeat consultation.
4What Your Clinical Note Must Show
To ensure proper billing of C266, the following documentation is required:
- New written request from a referring physician, nurse practitioner, or dental surgeon.
- Documentation of the patient’s changed condition necessitating the repeat consultation.
- Record of the consultation rendered, including findings and recommendations.
5Weak vs. Strong Note Examples
The strong note succeeds by explicitly detailing the clinical need for the repeat consultation, the source of the referral, and specifics of the patient’s condition and management. The weak note fails because it lacks specifics on the request or any notable changes in the patient's condition.
Reassessment of the patient completed today. No significant issues noted.
A repeat consultation was conducted following a written request from Dr. Smith due to a significant change in the patient's respiratory status. The patient presented with increased wheezing, and after evaluation, a new management plan was discussed and implemented.
- Specific change in clinical status described
- Reference to written request received
- Detailed findings from the repeat consultation
