W021 – Additional subsequent visits in chronic care or convalescent hospital (maximum 6 per patient per month)
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service is a routine subsequent assessment by a specialist in Dermatology (02) for a patient in a chronic care or convalescent hospital. It follows the initial admission assessment and is part of ongoing care. This specific code applies to the 5th and 6th subsequent visits within a single calendar month for a patient, after the first four visits have been claimed using W022. As per , this assessment includes a direct physical encounter, history taking, examination, making arrangements for related care, and providing advice to the patient or their representative. Visits for acute intercurrent illnesses should be claimed using W121 and are not subject to these limits.
When to Use
- Use W021 only for the 5th and 6th routine subsequent visits in a calendar month after four W022 claims have already been submitted.
- Use this code for ongoing chronic care management when the patient's condition is stable and does not meet the criteria for an acute intercurrent illness claim under W121.
Common Pitfalls
- Billing W021 before exhausting the four-visit limit for W022 will result in an automatic rejection or audit flag for incorrect code sequencing.
- Claiming W021 for an acute intercurrent illness instead of W121 is a common error that ignores the specific clinical intent of the chronic care visit structure.
Billing Tips
- Track your monthly visit count per patient carefully, as the Ministry system will reject any claims exceeding the combined total of six visits for W022 and W021.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
In order to claim this service, the medical record must establish that an insured service was provided, the service claimed is the service that was rendered, and the service was medically necessary.
Additional subsequent visits (maximum 6 per patient per month) per visit.
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