1What Is the C466 OHIP Code?
The C466 OHIP billing code is used for repeat consultations pertaining to infectious diseases in a hospital in-patient setting. These consultations occur when changes in a patient's condition warrant a second examination by the same consultant. This could happen, for example, if an admitted patient's fever or underlying infectious condition changes, necessitating a further, in-depth evaluation.
Repeat consultations are typically requested by the ward team following assessment by another physician. The new request must be supported by the referring healthcare provider's documentation, ensuring the appropriateness of further consultation. Conventionally missed opportunities for billing this code may arise from failing to document the necessity of the repeat evaluation or from lapses in requesting provider's written referrals.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A275 | Limited consultation | Refer to Schedule | Limited consultation service for infectious disease issues. |
| A460 | Comprehensive infectious disease consultation | Refer to Schedule | Comprehensive consultation for complex infectious disease cases. |
| A465 | Consultation | Refer to Schedule | Standard consultation for infectious disease cases. |
| A466 | Repeat consultation | Outside hospital in-patient settings | Repeat consultation service rendered outside hospital settings same as C466. |
3Eligibility Requirements
To be eligible for billing code C466, the repeat consultation must follow the initial consultation for the same patient and the same condition, and can occur after another physician has intervened in care. Each repeat consultation requires a new written request from the referring physician, nurse practitioner, or dental surgeon.
In addition, the consultation can only be performed in a hospital in-patient setting, not in outpatient clinics. The eligibility also excludes this service from the consultation frequency limits, but the same diagnosing consultant must provide the service.
Virtual consultations can be conducted via video under code C466A, but telephone consultations are not eligible.
4What Your Clinical Note Must Show
The start and stop times of the consultation must be recorded in the medical record.
- Document start and stop times accurately.
- Maintain a copy of the referral request in the medical record.
A written request for the repeat consultation must be retained unless conducted in a setting with a shared medical record.
- Ensure the referral is signed by an authorized clinician.
- Record the reason for the repeat consultation.
5Weak vs. Strong Note Examples
The strong note includes comprehensive details on the time spent, the condition change, and adherence to documentation guidelines, ensuring full eligibility for billing.
Repeat consultation performed, discussed patient's condition with the team. Patient referred by Dr. Smith.
No detailed assessment recorded.
Repeat consultation conducted with patient in response to febrile condition change, as requested by ward team. Case discussed with Dr. Smith.
Start time: 14:00 | End time: 14:45. Detailed assessment documented in patient's medical record.
- Updated assessment recorded
- Reason for consultation explicitly noted
- Complete referral documentation included
