W130 – Comprehensive Internal Medicine Consultation
OHIP Neurology Code — Internal and Occupational Medicine (13) · Schedule of Benefits
A comprehensive internal medicine consultation provided to a non-emergency in-patient in a Long-Term Care Institution. Per the Schedule, this service is subject to the same conditions as A130. A consultation is an assessment rendered following a written request from a referring practitioner for an expert opinion on a patient's condition due to its complexity, seriousness, or obscurity. The consulting physician must provide a written report of findings, opinions, and recommendations to the referring practitioner. For payment, the written request must be kept in the patient's medical record.
When to Use
- Use W130 for a non-emergency, comprehensive internal medicine assessment of a patient residing in a Long-Term Care (LTC) facility following a formal written request.
- Use W130 when the patient requires an expert opinion on a complex, serious, or obscure condition that necessitates a formal consultation report back to the referring practitioner.
Common Pitfalls
- Billing W130 for emergency assessments in an LTC setting; these must be billed using A130 plus the appropriate Special Visit Premium.
- Failing to ensure the referring physician's name and billing number are explicitly recorded, which is a mandatory requirement for audit compliance.
- Attempting to bill W130 when the referral was requested by the consultant after the service was already performed, which renders the consultation ineligible.
Billing Tips
- Ensure the written referral request is clearly dated and filed in the patient's record before the consultation occurs to satisfy the Schedule of Benefits requirements.
- If the patient has been seen by you for the same diagnosis within the previous 12 months, W130 will be rejected; use a subsequent visit code instead.
Effective: June 1, 2025
Consultations and Visits
Internal and Occupational Medicine (13)
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. In a facility with a common medical record, the written request may be contained on the common medical record.
The request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number.
The written request must set out the information relevant to the referral and specify the service(s) required.
The consultant must prepare a written report including findings, opinions, and recommendations to the referring physician, nurse practitioner or dental surgeon.
Subject to the same conditions as A130.
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