W078 – Subsequent Visit - Nursing Home or Home for the Aged
OHIP Neurology Code — Geriatrics (07) · Schedule of Benefits
A subsequent visit is any routine assessment following the patient's admission to a long-term care institution (see ). W078 is specifically for subsequent visits provided by a Geriatrics specialist to a patient in a nursing home or home for the aged. This service is payable for the third, fourth, and fifth subsequent visits in a single calendar month for the same patient by the same physician. The first two subsequent visits in the month must be claimed using W073. This service is a component of the monthly management fee (W010) and is not payable in the same month that W010 is claimed. Visits for an acute intercurrent illness should be claimed as W121 and are not subject to the monthly visit limits. For emergency calls or other special visits, an 'A' prefix General Listing code and the appropriate special visit premium must be used.
When to Use
- Use W078 for the third, fourth, and fifth routine follow-up visits to a nursing home patient within a single calendar month.
- Use this code specifically when the patient is under your care as a Geriatrics specialist and you are not billing the monthly management fee W010.
Common Pitfalls
- Billing W078 for the first or second visit of the month, which must be claimed as W073 to avoid automatic rejection.
- Attempting to claim W078 in the same month as the monthly management fee W010, which is a prohibited billing combination.
- Using W078 for acute intercurrent illnesses instead of W121, which causes the visit to count against your monthly limit.
Billing Tips
- Track your monthly visit count per patient carefully to ensure you transition from W073 to W078 only after the second visit is completed.
- If a patient requires an urgent, non-routine assessment, bill an 'A' prefix code with the appropriate special visit premium instead of W078 to ensure proper compensation.
Effective: June 1, 2025
Consultations and Visits
Geriatrics (07)
Assessment
Hospital and Institutional Consultations and Assessments
See General Preamble for rules regarding subsequent visits in Long-Term Care Institutions.
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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