W003 – Subsequent visits - Nursing home or home for the aged
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit is any routine assessment following the patient's admission to a long-term care institution. These services apply to patients in chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged and designated chronic or convalescent care beds in hospitals, excluding patients in designated palliative care beds (see ). W003 is considered a component of the Monthly Management fee (W010) and is not payable separately when W010 is claimed (see , ).
When to Use
- Use W003 for routine, non-acute follow-up assessments in a long-term care facility when you are not claiming the Monthly Management fee (W010) for that month.
- Use W003 for the first subsequent visit in a month if you have not yet reached the threshold to bill W010 or if you are not the physician responsible for the monthly management fee.
Common Pitfalls
- Billing W003 in the same month as W010 will result in an automatic rejection, as W003 is considered a component of the monthly management service.
- Mistaking W003 for an acute visit; if the patient has an acute intercurrent illness, you must use W121 instead to ensure payment regardless of the W010 status.
Billing Tips
- If you provide more than one visit in a month for an acute issue, prioritize billing W121 for those acute encounters to avoid the restrictive monthly limits associated with W003.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
Submit claims for acute intercurrent illnesses requiring visits other than special visits using W121. When acute intercurrent illness requires a special visit, submit claims using the appropriate fees under General Listings (“A” prefix) and premiums.
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