W121 – Additional Visit Due to Intercurrent Illness (Long-Term Care)
OHIP Neurology Code — Family Practice & Practice in General (00) · Schedule of Benefits
A visit for an acute intercurrent illness in a Long-Term Care Institution (chronic care hospital, convalescent hospital, nursing home, home for the aged, or designated chronic/convalescent care bed). It is used for visits other than special visits. Claims for W121 are payable for visits for acute intercurrent illness whenever rendered and are not dependent on whether the monthly limit on the number of subsequent visits has been reached. When an acute intercurrent illness requires a special visit, claims must be submitted using the appropriate 'A' prefix assessment code and the corresponding special visit premium. This service is included in the W010 monthly management fee unless it is the fifth or subsequent 'W' prefix visit in a calendar month by the MRP.
When to Use
- Use W121 when you have already reached the monthly limit of four 'W' prefix visits for a patient and need to bill for a fifth or subsequent visit due to an acute intercurrent illness.
- Use W121 for an acute, non-special visit assessment in a long-term care facility that occurs outside of the routine monthly management covered by W010.
Common Pitfalls
- Billing W121 for a visit that qualifies as a special visit; these must be billed using 'A' prefix codes with appropriate premiums instead.
- Failing to include the manual review indicator when submitting W121 claims that are intended to be paid in addition to W010, resulting in automatic rejection.
- Attempting to bill W121 for routine follow-ups that do not meet the clinical definition of an acute intercurrent illness.
Billing Tips
- Ensure you only use W121 for the fifth or subsequent 'W' prefix visit in a calendar month if you are the MRP, as the first four are typically bundled into W010.
Effective: April 1, 2026
Consultations and Visits
Family Practice & Practice in General (00)
Assessment
Hospital and Institutional Consultations and Assessments
Submit claims for acute intercurrent illnesses requiring visits other than special visits using W121.
When acute intercurrent illness requires a special visit, submit claims using the appropriate fees under General Listings ('A' prefix) and premiums.
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