W074 – General reassessment of patient in nursing home
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A general reassessment of a patient in a nursing home, performed according to the requirements of the Nursing Homes Act. As a general re-assessment, it includes all the services listed for a general assessment, with the exception that the patient's history need not include all the details already obtained in the original assessment (see ). This service is intended for non-emergency, inpatient care in long-term care settings. According to the note on , it may only be claimed 6 months after a Periodic health visit has been performed.
When to Use
- Use W074 when performing the mandatory annual or periodic general reassessment required by the Nursing Homes Act for a long-term care resident.
- Use this code for a comprehensive, head-to-toe physical examination that exceeds the scope of a standard W279 visit.
Common Pitfalls
- Billing W074 in the same month as W010 will result in an automatic rejection, as the monthly management fee covers routine reassessments.
- Claiming W074 before the 6-month interval has elapsed since the patient's last Periodic Health Visit (K017) will trigger a rejection.
- Failing to document a comprehensive physical examination of all relevant body systems will lead to clawbacks during a Ministry audit.
Billing Tips
- Ensure your documentation explicitly references the 'General Reassessment' requirements to distinguish it from a routine W279 visit, which only requires a focused assessment.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
The service must include all the required elements of a general assessment as per and , including a comprehensive history (though details already obtained may be omitted) and an examination of all body parts and systems (except where not medically indicated or refused).
*May only be claimed 6 months after Periodic health visit (as per the Nursing Homes Act)
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