W134 – General Re-Assessment of Patient in Nursing Home (As per the Nursing Homes Act)
OHIP Neurology Code — Internal and Occupational Medicine (13) · Schedule of Benefits
A general re-assessment rendered to a patient in a nursing home, as per the Nursing Homes Act. This service falls under Non-Emergency Long-Term Care In-Patient Services. According to , a general re-assessment includes all the services of a general assessment, but the patient's history does not need to include all details already obtained in the original assessment. For emergency calls and other special visits to in-patients, physicians should use General Listings (A prefix codes) and the applicable Special Visit Premiums.
When to Use
- Use W134 for the mandatory periodic general re-assessment required by the Nursing Homes Act, provided at least 6 months have elapsed since the last periodic health visit.
- Use this code for routine, non-urgent clinical reviews of a nursing home patient that do not meet the criteria for an acute intercurrent illness visit (W121).
Common Pitfalls
- Billing W134 for an acute intercurrent illness; use W121 for acute issues or A-prefix codes with Special Visit Premiums if the visit is urgent and requires a specific trip.
- Submitting W134 within 6 months of a periodic health visit, which will trigger an automatic rejection as it violates the Nursing Homes Act frequency requirements.
- Attempting to bill W134 for an emergency assessment of another physician's patient, which must be billed using A-prefix codes to ensure eligibility for Special Visit Premiums.
Billing Tips
- Always apply the 15% age premium for patients 65 and older to maximize the claim value, as this is specifically permitted for W134 under GP64.
Effective: June 1, 2025
Consultations and Visits
Internal and Occupational Medicine (13)
Assessment
Hospital and Institutional Consultations and Assessments
May only be claimed 6 months after Periodic health visit (as per the Nursing Homes Act).
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