W085 – Consultation
OHIP Neurology Code — Plastic Surgery (08) · Schedule of Benefits
This service is for a non-emergency consultation by a Plastic Surgeon for a patient in a Long-Term Care Institution, which includes Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, and designated chronic or convalescent care beds in hospitals (other than designated palliative care beds). As per the definition on page , a consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon. It requires a comprehensive assessment of the patient's condition, a review of all relevant data, and the preparation of a written report with findings, opinions, and recommendations sent back to the referring practitioner.
When to Use
- Use W085 for the initial assessment of a patient in a long-term care facility when requested by the attending physician to evaluate a specific plastic surgery issue, such as a complex pressure ulcer or chronic wound.
- Use W085 when providing a formal consultation for a patient residing in a nursing home or chronic care hospital, provided a written referral is documented in the patient's chart.
Common Pitfalls
- Billing W085 for routine follow-up visits or repeat assessments, which should be billed as subsequent visits (e.g., W086) rather than a consultation.
- Failing to document the written request from the referring practitioner, which will lead to a reduction of the fee to a lesser assessment code upon audit.
- Billing W085 for patients in acute care hospital beds; W085 is strictly for long-term care, chronic care, or nursing home settings.
Billing Tips
- Ensure the referring practitioner's name and billing number are clearly linked to the consultation request in your records to satisfy the GP16 documentation requirements.
- If the consultation occurs in a facility with a common medical record, ensure the referral request is explicitly noted within that record to avoid rejection for missing documentation.
Effective: June 1, 2025
Consultations and Visits
Plastic Surgery (08)
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
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, 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.
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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