1What Is the W346 OHIP Code?
The W346 billing code applies to repeat consultations within the field of Otolaryngology (ENT) in Ontario. This code is used when a patient requires an additional consultation for the same presenting problem after care has been provided by another physician. Examples include re-evaluating a long-term care resident with recurrent aspiration or chronic ear disease where decision-making on deferred procedures might need updating.
ENT specialists frequently encounter cases where a patient's condition evolves or is reassessed over time, necessitating repeat consultations. It's crucial to ensure a new written request is received from the referring physician, nurse practitioner, or dental surgeon for each repeat consultation.
Common reasons this code might be overlooked include lack of awareness of the requirement for a new written request or confusion over consultation frequency rules. Unlike initial consultations, repeat consultations require fewer restrictions on frequency, provided the proper documentation is maintained.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | Limited by specific conditions | Advanced surgical assessment for otolaryngology cases. |
| C935 | Special surgical consultation | Limited by specific conditions | Similar to A935, advanced evaluation often requiring hospital setting. |
| A245 | Consultation | Subject to GP17 limitations | Initial consultation service in ENT. |
| A246 | Repeat consultation | Excludes GP17 frequency limits | Equivalent to W346 in scenario and use. |
3Eligibility Requirements
Eligibility Requirements for Billing W346
To bill for the W346 repeat consultation, ensure that:
- A copy of the written request for the consultation, signed by the referring physician, nurse practitioner, or dental surgeon is maintained in the consulting physician's medical record.
- This requirement is waived if the consultation occurs in a hospital, long-term care institution, or multi-specialty clinic where common medical records are used.
- The consultation addresses the same presenting problem following care by another physician, and the referral is accompanied by a new request.
Failure to meet these requirements will result in the service being adjusted to a general or specific assessment fee.
4What Your Clinical Note Must Show
The consulting physician's records must include:
- A new written request signed by the referring professional.
- Documentation of the repeat nature of the consultation.
- Specific details of changes in patient status or treatment needs.
5Weak vs. Strong Note Examples
The strong note is successful because it explicitly refers to the new consultation request and outlines clinical progression, whereas the weak note lacks specific clinical details and context.
Patient seen for throat pain as previous consultation. Referred by Dr. Jones. Follow-up as per plan.
Patient referred by Dr. Jones for evaluation of chronic ear disease with deteriorated symptoms. Previous assessment was 6 months ago for recurrent aspiration. New requests include updated audiometry results indicating increase in hearing loss. Discussed potential need for surgical intervention and planned additional diagnostics.
- Clear referral source and reason.
- Detailed patient history and current condition.
- Specific plans or changes in treatment strategy.
