1What Is the C626 OHIP Code?
What is C626?
The C626 code is designated for repeat consultations in the field of Allergy and Immunology, specifically for in-patient settings. These repeat consultations are necessary when a patient has further allergic reactions or when the initial treatment plan needs adjustment due to ineffectiveness.
This code is frequently missed due to misunderstandings about the conditions that warrant a repeat consultation, or failure to secure a new written request from the referring provider.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A525 | Limited consultation | N/A | Limited initial consultation for allergy and immunology. |
| A625 | Consultation | N/A | Complete initial consultation for allergy and immunology. |
| A626 | Repeat consultation | N/A | Repeat consultation rendered in an out-patient setting. |
| C525 | Limited consultation | N/A | Limited consultation within a hospital for allergy and immunology. |
3Eligibility Requirements
Eligibility for C626
- Virtual Delivery: C626 can be rendered virtually as C626A, but only through video conferencing. Telephone consultations don’t qualify for billing under this code in the virtual care setting.
- Referral Requirement: Each repeat consultation must have a new written request from a referring physician, nurse practitioner, or dental surgeon.
- Exclusions: While repeat consultations are excluded from the general frequency limitations, if the repeat consultation criteria are not met, billing must default to a general or specific assessment.
4What Your Clinical Note Must Show
Ensure proper documentation of each repeat consultation request.
- New written request from referring physician, nurse practitioner, or dental surgeon
- Document medical necessity for repeat consultation
5Weak vs. Strong Note Examples
The strong note shows the medical necessity and a clear adaptation in the treatment plan, whereas the weak note lacks detail about the assessment and rationale for another consultation.
Patient seen again today after initial consult. Symptoms persist.
Patient was reassessed due to continued allergic reactions despite initial treatment plan. After reevaluation, adjusted management strategy to include additional antihistamines. Follow-up required.
- Documented persistence of symptoms and previous treatment plan failures.
- Clear indication of reassessment and treatment adjustment.
