1What Is the W646 OHIP Code?
The W646 OHIP billing code is applicable for repeat consultations conducted by a thoracic surgeon in a non-emergency, long-term care setting. This code is valuable when a patient has been seen previously for a thoracic condition and requires another consultation due to a change in symptoms or care goals. W646 can be crucial when the clinical scenario shifts from surgical intervention to balancing management and comfort care.
Repeat consultations differ from initial consultations, as they require new written requests from referring clinicians and are specific to the involved issue following interim care by another physician.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | Restricted; often distinct patient scenarios | For unique, complex surgical consults within thoracic surgery requiring comprehensive evaluation. |
| C935 | Special surgical consultation | Restricted; often distinct patient scenarios | Analogous to A935, used in alternative billing contexts. |
| A645 | Consultation | Once per patient per condition | Initial thoracic surgery consultation for a new presenting problem. |
| A646 | Repeat consultation | Per new referral for the same problem | Standard repeat consultation billing for general thoracic surgery. |
3Eligibility Requirements
Eligible settings for W646 include non-emergency long-term care facilities such as chronic care and convalescent hospitals, nursing homes, and homes for the aged, provided they are not designated palliative care beds. To bill W646, you must have a documented new written request for the consultation from another medical professional. The code is excluded from the GP17 consultation frequency limits but each use requires adherence to the specific documentation and referral requirements.
4What Your Clinical Note Must Show
Maintain a copy of the written consultation request signed by the referring healthcare provider.
- Referring physician, nurse practitioner, or dental surgeon's signature must be present.
Ensure all documentation aligns with consultation specifics and referral requirements.
- Patient ID and diagnosis must be consistent with prior records.
- Consultation notes should reflect continuity and changes in patient care.
5Weak vs. Strong Note Examples
The strong note effectively captures both the clinical context and administrative necessity for the consultation, whereas the weak note fails to provide sufficient documentation or justification for billing under W646.
Patient seen for repeat consultation regarding ongoing symptomatic management. No new significant details recorded.
Repeat consultation performed due to new referral following patient's change in clinical status. Discussed alterations in operative risk versus symptomatic management given recent deterioration.
- New referral letter attached.
- Documented change in patient's symptoms or goals of care.
