1What Is the W036 OHIP Code?
What is OHIP Billing Code W036?
OHIP billing code W036 refers to a repeat consultation service provided by a general surgeon. This code applies when a second or subsequent consultation is necessary due to a change in the patient’s condition or care provided by another physician.
In the context of general surgery, this could involve a scenario such as a long-term care resident experiencing deterioration in a wound that requires reassessment after an initial consultation. Such consultations are important for revisiting surgical decisions that may have been deferred earlier due to changes in the patient's health status.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | Per episode of care | Used for in-depth consultations requiring specialized surgical advice. |
| C935 | Special surgical consultation | Per episode of care | A comprehensive consultation that includes detailed surgical evaluation. |
| A035 | Consultation | One per two consecutive 12 month periods | Standard consultation service for initial opinions on surgical issues. |
| A036 | Repeat consultation | As required with new referral | Used for follow-up consultations prompted by new referrals. |
3Eligibility Requirements
Eligibility Requirements for Billing W036
To bill W036, a repeat consultation:
- Written Request: Must be based on a new written request from a referring physician, nurse practitioner, or dental surgeon. This request should outline the need for a follow-up assessment.
- Medical Record: A copy of this request must be included in the medical records maintained by the consulting surgeon unless the consultation occurs within a common record environment like a hospital or long-term care institution.
- Specific Circumstances: Must follow care intervened by another physician prior to the repeat consultation for the same issue.
The ability to bill a repeat consultation is not subject to the usual frequency limits applied to consultation services, allowing flexibility for general surgeons who need to re-evaluate patients due to evolving clinical situations.
4What Your Clinical Note Must Show
Ensure the following documentation is maintained:
- A new written request from a referring physician, nurse practitioner or dental surgeon.
- Inclusion of this request in the surgeon's medical records, unless institutional records apply.
5Weak vs. Strong Note Examples
The strong note clearly documents the referral, the specific clinical change, and the actions taken, whereas the weak note lacks detail and specificity regarding the consultation's necessity.
Reviewed patient. Same issue as before. Will monitor.
Repeat consultation performed following request by Dr. Smith for deteriorating wound condition. Reviewed past treatment plans, examined current wound status, and made recommendations for changes in care due to new symptoms.
- Note details the change in patient condition.
- Reference to the referral and who made it.
