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W131
W131 – Additional Subsequent Visit - Chronic Care or Convalescent Hospital
OHIP Neurology Code — Internal and Occupational Medicine (13) · Schedule of Benefits
Represents an additional routine subsequent visit for a patient in a chronic care or convalescent hospital. These visits are limited to a maximum of 6 per patient per month, in combination with W132 (first 4 visits). This code is used for the 5th and 6th visit. For visits due to an acute intercurrent illness, use W121. Refer to for general rules on subsequent visits in long-term care institutions.
When to Use
- Use W131 only for the 5th and 6th routine chronic care visits in a calendar month after W132 has been billed 4 times.
- Apply this code for stable patients requiring routine monitoring in a chronic care or convalescent facility where no acute intercurrent illness is present.
Common Pitfalls
- Billing W131 before exhausting the 4-visit limit of W132 will result in automatic rejection.
- Using W131 for visits involving acute intercurrent illness instead of W121 is a common audit trigger for inappropriate code selection.
- Exceeding the combined monthly limit of 6 visits for W132 and W131 will lead to claim denials.
Billing Tips
- Track your monthly visit count per patient carefully to ensure you switch from W132 to W131 exactly on the 5th visit.
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