1What Is the W066 OHIP Code?
A repeat consultation (W066) under OHIP is an additional assessment provided by the same orthopaedic consultant for the same issue after another physician has intervened in the patient's care. This applies to instances such as assessing a long-term care resident previously seen for post-fall complications, when there is a need to re-evaluate the approach to treatment, such as deciding between surgical intervention and continued conservative management.
Often, the need for a repeat consultation arises when new clinical circumstances in the patient’s health indicate a possible change in treatment strategy. It is crucial for enhancing patient care by revisiting prior recommendations in light of new health developments, ensuring that the patient's current condition is adequately addressed. These consultations require a new referral from a referring clinician, emphasizing coordinated care among providers.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | No frequency limits indicated | A comprehensive surgical assessment requiring enhanced expertise, billed at $194.65. |
| C935 | Special surgical consultation | No frequency limits indicated | Another listing for special surgical consultation requiring enhanced expertise, billed at $194.65. |
| A065 | Consultation | Subject to frequency limits | Initial consultation service, billed at $89.80. |
| A066 | Repeat consultation | Not subject to standard frequency limits | Similar to W066, A066 applies generally outside the Orthopaedic listings, also billed at $55.35. |
3Eligibility Requirements
To bill using the W066 code, the following eligibility requirements must be met:
- New Written Request: The repeat consultation must be preceded by a new written referral from a physician, nurse practitioner, or dental surgeon. This referral should be maintained in the consultant's records, except in shared-record environments like hospitals or LTC facilities.
- Follow-Up on Previous Consultation: The repeat consultation should follow care by another physician for the same issue that necessitated the original consultation, but occur after new clinical interventions have taken place.
- Exclusion from Frequency Limits: Repeat consultations can be billed without being subjected to the usual consultation frequency restrictions, allowing flexibility in managing complex cases over time.
Failure to meet these criteria will result in adjustment of the fee to that of a general or specific assessment.
4What Your Clinical Note Must Show
For each repeat consultation claim, the medical record must include the following:
- A copy of the new written request signed by the referring healthcare provider.
- Detailed notes from the repeat consultation documenting the clinical rationale for the reassessment.
- Documentation of any changes in the treatment plan or patient condition.
5Weak vs. Strong Note Examples
The strong note provides comprehensive details, including referral source, precise clinical findings, and outlines the decision-making process involving all stakeholders, whereas the weak note lacks specifics and fails to justify the use of a repeat consultation code.
Patient was seen again after prior consultation. Referral on file. Discussed possible surgery.
Repeat consultation for Mr. Smith, aged 78, following a fall-related injury previously assessed on. Seen after referral on 10/20/23 by Dr. Adams due to persisting knee pain and limited mobility despite conservative management.
Discussed surgical intervention given lack of improvement and patient's deteriorating function. Notes indicate comprehensive evaluation including updated imaging and patient preference considered.
Decision collectively reviewed with primary care and family, noting potential benefits of surgery.
- New referral noted and documented in patient's records.
- Documented clinical judgment calls and considerations.
