1What Is the W076 OHIP Code?
W076 is an OHIP billing code for repeat consultations in geriatrics, used when a patient requires an additional assessment addressing the same issue after initial management. It applies strictly to non-emergency long-term care in-patient services such as nursing homes and chronic care hospitals.
Geriatricians often use this code to revisit a case involving behaviors related to dementia when prior treatment strategies have not succeeded. Given its specific eligibility requirements, it's commonly overlooked due to confusion between repeat and initial consultations or misunderstanding of what constitutes as 'new' written requests.
Remember, a successful billing requires a documented new written request for each repeat consultation, which captures the necessity of further specialist evaluation after initial interventions have been attempted by another healthcare provider.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A070 | Consultation in association with special visit | As applicable per visit | Used for consultations associated with special hospital visits. |
| A075 | Consultation | One service per patient per 12 months | The standard consultation code in the Geriatrics listings. |
| A076 | Repeat consultation | Excluded from frequency limits | Serves the same role as W076 for primary Geriatrics settings. |
| A375 | Limited consultation | As required | Used for briefer consultations. |
3Eligibility Requirements
Eligibility Requirements
- Setting: Applicable for non-emergency long-term care in-patient services including chronic care hospitals, convalescent hospitals, nursing homes, and homes for the aged.
- Written Request: A repeat consultation requires a new written request from a referring physician, nurse practitioner, or dental surgeon, which must be retained in the consulting physician's records.
- Virtual Services: Repeat consultations can be delivered via video, billed as W076A. Telephone consultations are not eligible.
- Frequency: Excluded from general consultation frequency limits, allowing for flexibility in providing subsequent consultations across care intervals. However, each repeat must adhere to the conditions outlined in General Preamble GP19.
4What Your Clinical Note Must Show
Each repeat consultation must have formal documentation retained in the patient's record.
- A copy of the written request by referring physician.
- Patient charts demonstrating interval management by another physician.
- Documented necessity for further specialist intervention.
5Weak vs. Strong Note Examples
Patient seen for repeat consultation.
Discussed persistent behavioral issues in dementia.
Follow-up arranged.
Repeat consultation conducted on request dated [insert date] from Dr. Smith.
Consultation focused on reassessing dementia-related behaviors following unsuccessful management by facility physician.
Plan discussed involving changes to medication and environment interventions for better outcome.
- Ensure referral copy is attached.
- Clarify medication changes suggested.
