1What Is the W306 OHIP Code?
The W306 billing code under OHIP is designated for repeat consultations in the field of Obstetrics and Gynaecology. This service is essential for patients requiring ongoing specialist evaluation after initial consultations, especially when symptoms evolve or there has been interim care by different physicians.
Clinically, this code is commonly used for situations including but not limited to assessments for gynecological problems such as prolapse, atrophic bleeding, or pelvic masses that need further evaluation or have shown changes.
A frequent reason this code is missed is the requirement for a new written referral from a referring physician or qualified practitioner, which is mandatory for each repeat consultation to qualify for billing under W306.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | N/A | Used for complex, special surgical consultations in Obstetrics and Gynaecology, eligible for higher reimbursement. |
| C935 | Special surgical consultation | N/A | Applicable for complex consultations requiring surgical consideration, similar to A935 provision. |
| A205 | Consultation | N/A | Standard consultation fee for Obstetrics and Gynaecology. |
| A206 | Repeat consultation | N/A | Similar to W306 but listed distinctively in some contexts. |
3Eligibility Requirements
To be eligible for billing under the W306 code, the repeat consultation must adhere to the following criteria:
- Referral Requirement: A new written request must be provided by the referring physician, nurse practitioner, or dental surgeon. This documentation must be retained in the patient's medical record by the consulting physician unless the consultation takes place in settings maintaining common medical records like hospitals or multi-specialty clinics.
- Consultation Timing: The repeat consultation is applicable when continued care is necessary following an initial consultation, and the patient has received interim care from another physician.
- Included Services: Where indicated, the repeat consultation service includes biopsy of the cervix, the collection of cervical cancer screening specimens, and examination of trichomonas suspension.
Failure to meet these requirements will result in payment reclassification to a lesser assessment fee.
4What Your Clinical Note Must Show
Ensure you have a copy of the referral from the referring entity for each repeat consultation.
- Store this referral in the patient's medical record.
- Maintain records in accordance with OHIP guidelines and exceptions as applicable.
5Weak vs. Strong Note Examples
The strong note succeeds because it clearly documents the new referral, aligns with the requirements of altered symptoms necessitating further evaluation, and lists specific services provided.
Reviewed patient for recurrent pelvic mass. Continued symptoms warrant further investigation.
Reviewed patient following initial consultation for pelvic mass. Recent assessment by family physician documented altered symptoms, warranting further evaluation under repeat consultation requirements.
- New referral requested and obtained from family physician.
- Cervical biopsy and collection of screening specimens conducted, as indicated.
