1What Is the W236 OHIP Code?
The W236 code under OHIP is designated for repeat consultations in internal medicine. It allows physicians to conduct follow-up consultations when a patient's health condition necessitates a second look. This is particularly applicable in long-term care settings where patients with chronic conditions, such as decompensated heart failure or uncontrolled diabetes, require periodic reassessment by an internist.
This code is often missed because it requires a new written request from the referring provider, which distinguishes it from routine follow-ups. Incorrectly classifying visits without the written referral can lead to billing adjustments.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A130 | A130 Comprehensive internal medicine consultation | See Schedule | $342.25 for comprehensive evaluations |
| A135 | A135 Consultation | See Schedule | Standard internal medicine consultation at $192.85 |
| A136 | A136 Repeat consultation | See Schedule | Equivalent to W236 in fee and use |
| A435 | A435 Limited consultation | See Schedule | Limited consultations at $123.10 |
3Eligibility Requirements
To be eligible to bill W236 under OHIP, several specific conditions must be met:
- A new written request from a referring physician, nurse practitioner, or dental surgeon is mandatory for each repeat consultation.
- The code can only be used six months after a Periodic health visit as specified in the Nursing Homes Act.
Regarding virtual care, W236 can be billed as W236A if delivered via video, but it is not eligible when conducted by telephone, as outlined in Appendix J, Section 1 of the OHIP Schedule.
4What Your Clinical Note Must Show
To successfully bill this code, ensure the following documentation is part of the patient's file:
- A new written request for the repeat consultation from the referring physician, nurse practitioner, or dental surgeon
- Detailed clinical notes outlining the changes or exacerbations in the patient's condition
- Evidence of a six-month gap if following a Periodic health visit
5Weak vs. Strong Note Examples
The strong note succeeds by including a current referral and detailed information about the clinical changes and management plan, which are missing in the weak note.
Reviewed patient's diabetes. Follow-up recommended. No new referral.
Consultation conducted following new referral from Dr. Smith due to worsening diabetes control since the initial consultation.
Discussed changes in medication and management plan in detail.
- Referral document from Dr. Smith
- Clinical evidence supporting the change in condition
