W031 – Additional subsequent visits - chronic care or convalescent hospital
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit is a routine assessment following a patient's admission to a long-term care institution (see ). This specific service, W031, applies to additional subsequent visits for a patient in a chronic care or convalescent hospital. It is payable for visits rendered after the first four subsequent visits (see W032) in a calendar month, up to a maximum of six W031 visits per month. As per , an assessment includes a direct physical encounter with the patient, history taking, physical examination, and arranging for any related care.
When to Use
- Use W031 for the 5th through 10th subsequent visits in a calendar month for a chronic care patient, after the four W032 visits have been exhausted.
- Apply this code specifically for routine, ongoing monitoring of patients in chronic care or convalescent facilities where no acute intercurrent illness is present.
Common Pitfalls
- Billing W031 before exhausting the four allowed W032 visits will result in automatic rejection or adjustment by the Ministry.
- Attempting to bill W031 for an acute intercurrent illness; use W121 instead, as it is not subject to the monthly visit limits of the W032/W031 sequence.
- Exceeding the maximum of six W031 visits per month, as any services beyond this limit are non-payable.
Billing Tips
- Track your monthly visit count carefully; once you hit the 5th visit, switch your billing from W032 to W031 to ensure proper payment processing.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
The medical record must establish that: an insured service was provided; the service for which the account is submitted is the service that was rendered; and the service was medically necessary.
See General Preamble
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