W068 – 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 assessment for a patient in a nursing home or home for the aged, rendered by a specialist in Orthopaedic Surgery. As defined in the General Preamble (), a subsequent visit is any routine assessment following the patient's admission to a long-term care institution. These non-emergency services apply to patients in chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent care beds, but not patients in designated palliative care beds. Emergency calls and other special visits to these in-patients should be claimed using the General Listings ('A' prefix codes) and applicable Special Visit Premiums. This service is limited to a maximum of 3 visits per patient per month.
When to Use
- Use W068 for routine follow-up assessments of an orthopaedic condition for a patient residing in a nursing home when the visit does not qualify as an acute intercurrent illness.
- Use this code when performing a scheduled subsequent visit for a patient under your care in a long-term care facility, provided you have not already billed W010 for that patient in the same month.
Common Pitfalls
- Billing W068 in the same month as W010 will result in an automatic rejection, as the monthly management fee is intended to cover routine subsequent visits.
- Attempting to bill W068 for emergency or urgent assessments will lead to audit scrutiny; these must be billed using 'A' prefix codes with applicable Special Visit Premiums.
- Exceeding the 3-visit-per-month limit per patient will result in the rejection of the fourth claim.
Billing Tips
- If the patient develops an acute intercurrent illness requiring an assessment outside of routine care, bill W121 instead of W068 to ensure appropriate compensation for the acute event.
- Always verify if the facility is designated as a palliative care bed, as W068 is explicitly excluded for patients in these specific beds.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
Must meet the requirements for a subsequent visit, which is a type of assessment. This includes a direct physical encounter with the patient including an appropriate history and physical examination, advice to the patient, and an appropriate record. As per , a direct physical encounter with the patient is required.
See General Preamble for general rules on subsequent visits in long-term care.
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.