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W010
W010 – Monthly management fee
OHIP Consultations and Visits Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Monthly Management of a Nursing Home or Home for the Aged Patient is the provision by the most responsible physician (MRP) of routine medical care, management and supervision of a patient in a nursing home or home for the aged for one calendar month. The service requires a minimum of two assessments of the patient each month, where these assessments constitute services described as "W" prefix assessments. In addition to the common elements, this service includes the provision of the following services by any physician to the same patient during the month:
A. Services described by subsequent visits (e.g. W003, W008).
B. Services described by additional visits due to “intercurrent illness” (W121) except if the conditions described in Payment rule #7 are satisfied.
C. Services described by palliative care subsequent visits (e.g. W872).
D. Services described by admission assessments (e.g. W102, W104, W107).
E. Services described by periodic health visit or general re-assessments (e.g. W109, W004).
F. Services described by visit for pronouncement of death (W777) or certification of death (W771) except if the services are performed in conjunction with a special visit.
G. Service described by anticoagulation supervision (G271).
H. Completion of home care referral form and home care supervision (K070, K071, K072).
I. Services described by the following diagnostic and therapeutic procedures – venipuncture (G489), injection (G372, G373), immunization (G538, G590), collection of cervical cancer screening specimen(s) (G365, G394, E430, E431), intravenous (G379), and laboratory test codes (G001, G002, G481, G004, G005, G009, G010, G011, G012, G014).
J. All medication reviews.
K. All discussions with the staff of the institution related to the patient’s care.
L. All telephone calls from the staff of the institution, patient, patient’s relative(s) or patient’s representative in respect of the patient between the hours of 0700 hours and 1700 hours Monday to Friday (excluding holidays).
M. Ontario Drug Benefit Limited Use prescriptions/forms or Section 8 Ontario Drug Benefits Act requests.
The admission date of the patient must be provided on the claim for W010 or the service is not eligible for payment.
Payment for W010 is for management of the patient for the entire month for all the services listed as components of the W010 service, regardless of when the claim for W010 is submitted.
When claiming W010, do not also submit claims for "W" prefix services listed as components of the W010 for the same month.
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