W075 – Consultation - Non-Emergency Long-Term Care In-Patient Services
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service is a consultation for a patient in a non-emergency, long-term care in-patient setting. These settings include chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent care beds in hospitals or nursing homes/homes for the aged (excluding designated palliative care beds). A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon, who requests the opinion of a specialist due to the complexity, seriousness, or obscurity of the case. The consultant physician must perform a general, specific, or medical specific assessment, review all relevant data, and provide a written report with findings, opinions, and recommendations to the referring practitioner.
When to Use
- Use W075 when a specialist is requested to provide an opinion on a complex or obscure clinical issue for a patient residing in a long-term care facility or chronic care hospital.
- Use this code for a scheduled, non-emergency assessment where a formal written referral from a physician, nurse practitioner, or dental surgeon is present in the patient's chart.
Common Pitfalls
- Billing W075 when the referral request was generated by the consultant rather than the referring practitioner, which will result in a rejection or downgrade to a lower assessment fee.
- Failing to document the specific clinical question or reason for the consultation, which is a mandatory requirement for the 'consultation' designation versus a 'subsequent visit' (W076).
- Billing W075 for patients in designated palliative care beds, as these are explicitly excluded from the W075 definition.
Billing Tips
- Ensure the referring practitioner's name and billing number are clearly documented in the consultation report to satisfy audit requirements for a valid referral.
- If you see the patient again for the same condition, switch to W076 for subsequent visits, as W075 is intended for the initial consultative opinion only.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
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.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.