W113 – Subsequent visit – day of discharge
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A complex neurological assessment provided to a non-emergency in-patient in a long-term care setting, such as a chronic care hospital, convalescent hospital, nursing home, or home for the aged. The service is subject to the same conditions as A113. As an assessment, it includes the specific elements outlined in the Schedule (), such as a direct physical encounter, taking a patient history, and performing a physical examination.
When to Use
- Use W113 when performing the final discharge assessment for a patient in a chronic care or long-term care facility, provided the patient is not being discharged to an acute care hospital.
- Select W113 instead of A113 when the patient is located in a chronic care setting and you are completing the discharge process on the same day the patient leaves the facility.
Common Pitfalls
- Billing W113 on the same day as an E078 is a common rejection, as these codes are mutually exclusive for the same patient encounter.
- Failure to document start and stop times in the medical record will result in an automatic adjustment to a lower-valued assessment code during an audit.
- Attempting to bill W113 alongside another assessment code by the same physician for the same patient on the same day will lead to the rejection of the second service.
Billing Tips
- Ensure the discharge note clearly states the time spent on the assessment to satisfy the documentation requirement for the W113 fee.
- Verify the facility type qualifies as a chronic care or long-term care setting, as W113 is specifically restricted to these institutional environments.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
The start and stop times must be recorded in the patient’s permanent medical record or the amount payable for the service will be adjusted to a lesser paying fee.
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