W038 – Subsequent visits per month (maximum of 3 per patient per month) - Nursing home or home for the aged
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A routine subsequent visit for a patient in a nursing home or home for the aged, as defined in the General Preamble (). This service is any routine assessment following the patient's admission. As an assessment, it includes all specific elements such as a direct physical encounter, history taking, physical examination, arranging follow-up, and providing advice to the patient or their representative ().
This service is intended for non-emergency care. For emergency calls or other special visits to in-patients, A prefix General Listings codes and applicable Special Visit Premiums must be used instead (, ).
When to Use
- Use W038 for routine, non-urgent follow-up assessments in a nursing home when you are not billing the W010 monthly management fee for that patient.
- Use this code when providing a scheduled visit to address a specific clinical concern that does not meet the criteria for an emergency call or a special visit premium.
Common Pitfalls
- Billing W038 in the same month as W010 will result in an automatic rejection, as the monthly management fee is intended to cover all routine subsequent visits.
- Attempting to append a Special Visit Premium to W038 is a common error; if the visit is urgent enough to warrant a premium, you must use an 'A' prefix assessment code instead.
Billing Tips
- Ensure you track your monthly count carefully, as W038 is strictly capped at a maximum of three claims per patient per month.
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