W045 – Neurosurgery consultation - non-emergency long-term care in-patient
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service represents a consultation provided by a neurosurgeon for an in-patient within a Long-Term Care (LTC) setting, which includes chronic care hospitals, convalescent hospitals, nursing homes, and homes for the aged. As per the definition of a consultation in , this service requires a written request from a referring physician, nurse practitioner, or dental surgeon. The consultant must perform an assessment, review relevant data, and provide a written report with findings and recommendations back to the referring practitioner. This code applies to non-emergency situations; emergency calls or special visits to LTC in-patients should be billed using the appropriate 'A' prefix code from the General Listings along with a Special Visit Premium as described in -.
When to Use
- Use W045 for a non-urgent neurosurgical consultation requested for a patient residing in a chronic care hospital, nursing home, or home for the aged.
- Use this code when providing a formal opinion on a stable neurosurgical issue for an LTC patient, provided a written referral is documented in the chart.
Common Pitfalls
- Billing W045 for emergency neurosurgical assessments in LTC, which should instead be billed using 'A' prefix codes plus Special Visit Premiums under GP65-GP78.
- Failing to document a formal written request from the referring practitioner, which will lead to a payment adjustment to a lesser assessment fee upon audit.
- Billing W045 when the referral is initiated by a medical trainee rather than a physician, nurse practitioner, or dental surgeon, as this violates the consultation requirements.
Billing Tips
- Ensure the referral source name and billing number are clearly linked to the W045 claim to satisfy the GP16 documentation requirements.
- If the patient is under 16 years of age, remember to apply the appropriate age premium percentage to the W045 fee as outlined in GP64.
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 identifies the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
A consultation includes the services necessary to enable the consultant to prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon.
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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