W025 – Consultation - Non-Emergency Long-Term Care In-Patient Services
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation is an assessment rendered by a specialist for a patient in a long-term care institution following a written request from a referring physician, nurse practitioner, or dental surgeon. The referral is made due to the complexity, seriousness, or obscurity of the case, or because a second opinion is requested. This service includes a comprehensive assessment, review of all relevant data, and the preparation of a written report containing findings, opinions, and recommendations, which is sent to the referring practitioner. This service applies to patients in chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent care beds in hospitals, excluding designated palliative care beds. The 'W' prefix codes are used for these non-emergency in-patient services.
When to Use
- Use W025 when performing a comprehensive initial assessment of a patient in a nursing home or chronic care facility for a complex issue that requires a specialist's opinion.
- Use this code when a patient is transferred to a designated chronic care bed and you are asked to provide a formal consultation report to the referring physician for a new, distinct clinical problem.
Common Pitfalls
- Billing W025 for routine follow-up visits or ongoing management of a previously consulted condition, which should instead be billed as a subsequent visit code (e.g., W026).
- Failing to ensure a formal written referral request exists in the chart, as W025 is strictly prohibited without a documented request from a physician, NP, or dental surgeon.
- Attempting to bill W025 for patients in palliative care beds, as the code specifically excludes these settings.
Billing Tips
- Ensure your written report is sent to the referring practitioner and clearly documents the findings, opinion, and recommendations to satisfy the mandatory documentation requirement.
- If you are the same specialist who previously consulted on the same diagnosis, you cannot bill W025 again; you must use a subsequent visit code unless a new, unrelated condition has emerged.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
A copy of the written request for the consultation, signed by the referring physician, nurse practitioner, or dental surgeon must be kept in the consulting physician's medical record, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
The request must identify the consultant by name, the referring physician, nurse practitioner, or dental surgeon by name and billing number, and identify the patient by name and health number.
The written request must set out the information relevant to the referral and specify the service(s) required.
The consultant must prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner, or dental surgeon.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.