1What Is the C476 OHIP Code?
A repeat consultation under the OHIP billing code C476 refers to a respirology consultation provided to the same hospital in-patient addressing the same clinical issue following an initial assessment. This code is particularly applied in cases where there has been a further decline in the patient's respiratory function or a new treatment question arises. Respirologists often miss billing this code when failing to obtain a new written referral for the repeat consultation or misunderstanding the allowance of repeat consultations under OHIP's frequency constraints.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A470 | Comprehensive respiratory disease consultation | N/A | $342.25 fee for comprehensive initial consultation. |
| A475 | Consultation | N/A | $192.30 fee for standard consultation. |
| A476 | Repeat consultation | N/A | $119.35 fee for repeat consultation outside hospital in-patient settings. |
| A575 | Limited consultation | N/A | $119.35 fee for limited consultation. |
3Eligibility Requirements
To bill C476, the following eligibility requirements must be met:
- The consultation must occur in a non-emergency hospital in-patient setting under the Respiratory Disease listing.
- A new written request signed by the referring physician, nurse practitioner, or dental surgeon must be documented, unless the consultation occurs where shared medical records exist.
- C476 may be billed for virtual consultations if conducted via video, but not by phone.
Refer to the General Preamble GP16 and GP19 for comprehensive documentation and billing prerequisites.
4What Your Clinical Note Must Show
Maintain a copy of the written consultation request with the patient's medical records.
- Must be signed by the referring physician, nurse practitioner, or dental surgeon.
- Exempt in facilities with shared medical records.
5Weak vs. Strong Note Examples
The strong note is successful because it includes a specific reason for the repeat consultation, documented evidence of a new referral request, and detailed clinical context.
Patient seen again for respiratory issues.
No written request attached.
Repeat consultation requested by Dr. Smith due to worsening gas exchange.
New referral letter received and reviewed on patient's file.
- Referral explicitly details reasons for re-evaluation.
- Consultation focuses on updated status and treatment options.
