1What Is the W196 OHIP Code?
W196 represents the billing code used by psychiatrists in Ontario for repeat consultations with patients they have previously seen. This code is crucial in contexts where a patient, like a long-term care resident, experiences a resurgence or escalation of psychiatric symptoms, such as behavioral changes in dementia or unresponsive depression.
A repeat consultation typically occurs under circumstances necessitating reevaluation due to inadequate response to initial treatment strategies. It is distinct from routine follow-up visits and requires a new written request from the referring healthcare professional for verification of eligibility.
This code is often missed or incorrectly billed when follow-up visits are mistaken for repeat consultations without the appropriate referral documentation. Adhering to this requirement ensures compliance and proper reimbursement.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A190 | Special psychiatric consultation | N/A | Used for special psychiatric consultations requiring a comprehensive evaluation. |
| A195 | Consultation | N/A | Standard consultation for new or complex psychiatric evaluations. |
| A196 | Repeat consultation | N/A | Similar to W196, used in the psychiatry listing for repeat consultations. |
| A395 | Limited consultation | N/A | For consultations requiring limited re-evaluation or consultation. |
3Eligibility Requirements
To bill under code W196 for a repeat psychiatric consultation, the following eligibility criteria must be met:
- The consultation must be a repeat session following a previous consultation with the same patient.
- A new written request from the referring physician, nurse practitioner, or dental surgeon is required, verifying the necessity of the repeat consultation.
- Virtual delivery of the service is permissible as a video-only session under code W196A, as specified by OHIP Appendix J.
- Telephone consultations do not meet the requirements for billing under W196.
4What Your Clinical Note Must Show
The following documentation is required to support billing for a repeat consultation under code W196:
- New written request from the referring healthcare provider.
- Detailed clinical notes outlining the patient's current symptoms and lack of response to previous interventions.
- Evidence of the new diagnosis evaluation or revision of the treatment plan.
5Weak vs. Strong Note Examples
The strong note succeeds because it details the escalation of symptoms and aligns the consultation with a new referral need, whereas the weak note fails to demonstrate a clear justification for the repeat consultation.
Patient seen again for follow-up regarding depression. No significant changes observed.
Patient's behavioral symptoms of dementia escalated; previously prescribed antipsychotic taper failed.
New referral received for consultation focused on evaluating treatment resistance in depression.
- Reviewed current symptoms and prior treatment responses.
- Updated treatment plan based on consultation findings.
