1What Is the C356 OHIP Code?
A repeat consultation (C356) in the field of urology pertains to the revisiting of a patient previously assessed by the same urologist, following interim management by another physician. This is common in hospital in-patient settings, addressing ongoing issues such as obstructive uropathy. The repeat consultation must be prompted by a new written request from the referring physician, nurse practitioner, or dental surgeon. This ensures that the care is warranted for reassessment.
In urology, these consultations often involve confirmed diagnoses requiring a fresh perspective after initial treatments or diagnostics have resolved certain concerns or necessitated further evaluation. Misunderstandings regarding the need for such requests can lead to under-utilization and missed billing opportunities, particularly if the patient pathways and necessary documentation are not diligently followed.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | as necessary within urology specialties | For complex cases requiring specialized surgical consultation. |
| C935 | Special surgical consultation | as necessary within hospital in-patient urology settings | Applicable for in-depth surgical assessments. |
| A355 | Consultation | limited to one per patient every 12 months | Initial consultation for urology specialties. |
| A356 | Repeat consultation | varies based on need within out-patient settings | Similar to C356 but for out-patient settings. |
3Eligibility Requirements
For the C356 repeat consultation code eligibility, these are the primary requirements:
- Setting: The service must be provided in a non-emergency hospital in-patient setting.
- Request: A new written consultation request from the referring physician, nurse practitioner, or dental surgeon is mandatory. Copies of these requests should be retained in the consulting physician's records or within shared institutional records.
- Consultation Timing: The repeat consultation occurs after another physician's interim management of the same issue previously addressed.
- Frequency Limits: C356 is exempt from standard consultation frequency limits, allowing multiple uses with new requests.
- Virtual Consultation: The service can be billed virtually as ‘C356A’ if delivered via video, but not by telephone.
4What Your Clinical Note Must Show
Ensure you have a documented request for the repeat consultation.
- Signed by referring physician, nurse practitioner, or dental surgeon
- Filed in the consulting physician's medical records
Documentation must reflect the clinical need for a repeat consultation.
- Case involves reassessment of the same presenting problem
- Intervening care by another physician is evident
For hospital, long-term care, or multi-specialty clinic scenarios:
- Use common institutional records as appropriate
5Weak vs. Strong Note Examples
The strong note succeeds by providing clear evidence of clinical need and interim care, whereas the weak note lacks specifics on patient management and clinical reasoning.
Patient reassessed after initial consultation. No further detail provided.
Patient re-evaluated for obstructive uropathy post-management by Dr. Smith's internal medicine team.
Further assessment requested to evaluate the response to drainage and renal function stability.
- Documented consultations with referring and intervening physicians
- Detailed clinical reasoning for reassessment
