W072 – Subsequent visits - first 4 per patient per month - 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. This service applies specifically to patients in a chronic care or convalescent hospital and is billable for the first four subsequent visits per patient per month. This service is intended for non-emergency care and is not payable for patients in designated palliative care beds (use W982 instead). For emergency calls or other special visits, 'A' prefix General Listings and applicable premiums must be used. See for general rules on subsequent visits in long-term care.
When to Use
- Use W072 for routine, non-emergency follow-up assessments of patients admitted to a chronic care or convalescent hospital facility.
- Apply this code for the first four subsequent visits in a calendar month when the patient is not in a designated palliative care bed.
Common Pitfalls
- Billing W072 in the same month as W010 will trigger an automatic rejection, as the monthly management fee is intended to cover routine subsequent visits.
- Submitting W072 for patients in palliative care beds is a common audit trigger; use W982 for these patients instead.
- Attempting to bill W072 for emergency assessments performed while already in the facility will lead to denials; use 'A' prefix general listing codes for emergency services.
Billing Tips
- Monitor your monthly count for each patient closely, as W072 is strictly limited to the first four visits per patient per month.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
A subsequent visit is any routine assessment following the patient's admission to a long-term care institution. See for details.
Claims for 'W' prefix subsequent visits are subject to the specific limits described with each individual service listing.
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