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W026
W026 – Repeat consultation - Non-Emergency Long-Term Care In-Patient Services - Dermatology
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A repeat consultation for patients in chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent care beds in hospitals. This service falls under the Dermatology specialty (02) and is subject to the general rules for 'W' prefix services as outlined in General Preamble .
When to Use
- Use W026 for a repeat dermatology consultation for a patient under 18 years old residing in a long-term care facility or chronic care bed.
- Use this code when performing a follow-up assessment for a chronic skin condition in a nursing home patient where the visit does not meet the criteria for an acute intercurrent illness (W121).
Common Pitfalls
- Billing W026 when the patient is 18 years of age or older, as the code is strictly restricted to pediatric patients.
- Submitting W026 in the same month as W010 (Monthly Management) by the same physician, as the assessment is often considered bundled into the management fee.
- Attempting to bill W026 for an acute intercurrent illness; these must be billed under W121 to ensure payment regardless of monthly visit limits.
Billing Tips
- If you are already in the facility and are requested to assess another physician's patient on an emergency basis, use the 'A' prefix codes (e.g., A262) instead of W026 to ensure appropriate specialist compensation.
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