W104 – Admission assessment - Type 2
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Type 2 admission assessment occurs when the admitting physician makes an initial visit to assess the condition of the patient following admission to a long-term care institution and has previously rendered a consultation, general assessment or general re-assessment of the patient prior to admission. These services apply to patients in 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). This service is considered a component of the monthly management fee (W010) and is not separately payable if W010 is claimed in the same calendar month.
When to Use
- Use W104 when you admit a patient to a long-term care facility after having already performed a general assessment or consultation on that patient within the preceding period.
- Select W104 instead of W102 when you have an established clinical history with the patient prior to their institutional admission.
Common Pitfalls
- Claiming W104 in the same calendar month as the monthly management fee W010 will result in a rejection, as W104 is considered included in the W010 service.
- Billing W104 for an acute intercurrent illness is incorrect; these scenarios require 'A' prefix codes and applicable special visit premiums.
Billing Tips
- Verify that your billing software or manual entry excludes W104 if you have already submitted W010 for the patient in the current month to avoid automatic audit flags.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
The service must be documented in the patient's medical record, including a direct physical encounter, patient history, and physical examination, as required for all assessments.
'W' prefix codes apply to non-emergency in-patient services for patients in long-term care institutions, which includes chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged and designated chronic or convalescent care beds in hospitals other than patients in designated palliative care beds.
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