1What Is the W096 OHIP Code?
W096 is an OHIP billing code used for repeat consultations in cardiac surgery, typically in non-emergency long-term care settings. This consultation is provided after the patient has initially been seen and is now experiencing changes in symptoms or goals of care. Clinicians must use this code when reassessing conditions like valve or coronary disease to determine if surgical intervention is still appropriate.
A repeat consultation must be requested anew by a referring physician, nurse practitioner, or dental surgeon. As cardiac surgery often involves ongoing care and complex decision-making, the need for re-evaluation can be frequent, which is why W096 is exempt from certain consultation frequency limits.
A common oversight is failing to obtain a new written referral, which is essential for this billing code. Adequate documentation ensuring the necessity for a repeat consultation is critical to ensure compliance with OHIP guidelines.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | Varies | Used for special surgical consultations within cardiac surgery. |
| C935 | Special surgical consultation | Varies | Similar to A935 but depends on setting specifics. |
| A095 | Consultation | Limited to one service per two years for same diagnosis unless specified exceptions apply | Standard consultation in cardiac surgery. |
| A096 | Repeat consultation | Same as W096 | Used in similar contexts to W096 but outside of non-emergency long-term care. |
3Eligibility Requirements
Eligibility for using the W096 billing code requires the consultation to occur in a non-emergency long-term care inpatient setting, such as chronic care hospitals, nursing homes, or convalescent hospitals. The consultation should follow a change in the patient’s condition, and must involve a new written request from a referring physician, nurse practitioner, or dental surgeon. The written request must be maintained in the consulting physician's medical record unless common medical records are used by the institution.
4What Your Clinical Note Must Show
Maintain accurate and thorough records for each repeat consultation.
- Ensure a new written request from the referring provider is on file.
- Document the change in patient's condition or care goals prompting the repeat consultation.
- If applicable, confirm the consultation occurs in a setting maintaining common medical records.
5Weak vs. Strong Note Examples
The strong note succeeds because it documents the changes in the patient's condition and includes the necessary written referral request, whereas the weak note lacks such details.
Patient seen again for check-up. No new written request filed.
Repeat consultation requested by Dr. Smith due to patient's new symptoms of worsening dyspnea. Documented after initial consultation for valve disease last year.
Written request on file signed by referring provider.
- Details patient’s condition changes.
- Includes referential requests.
