W033 – Subsequent visits - nursing home or home for the aged - first 2 per patient per month
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A routine subsequent visit rendered by a General Surgeon to a patient in a nursing home or home for the aged. As per , a subsequent visit is any routine assessment following the patient's admission to a long-term care institution. This service applies to patients in nursing homes or homes for the aged, other than those in designated palliative care beds. The service includes the common elements of all insured services (see -) and the specific elements of assessments (), such as history taking, physical examination, and providing advice to the patient. This fee code is limited to the first two subsequent visits per patient per month.
When to Use
- Use W033 for routine, non-urgent follow-up assessments of a patient in a nursing home when you are not the primary physician claiming the W010 monthly management fee.
- Use this code for the first two monthly visits when providing surgical follow-up or chronic condition monitoring that does not meet the criteria for a special visit premium.
Common Pitfalls
- Billing W033 when the physician of record has already claimed W010 for the same patient in the same calendar month, which will result in an automatic rejection.
- Attempting to attach special visit premiums to W033; these are strictly prohibited and must be billed using 'A' prefix codes if an emergency visit is required.
Billing Tips
- If you anticipate seeing the patient more than twice in a month, ensure your billing software tracks the count to avoid submitting claims that exceed the monthly limit for this code.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
As per , all insured services must be documented in appropriate records establishing the service was provided and was medically necessary.
Non-Emergency Long-Term Care In-Patient Services includes Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, designated chronic or convalescent care beds in hospitals and nursing homes or homes for the aged, other than patients in designated palliative care beds.
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
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