W138 – Subsequent Visit, Nursing Home or Home for the Aged
OHIP Neurology Code — Internal and Occupational Medicine (13) · Schedule of Benefits
This service is a routine subsequent visit rendered by a specialist in Internal Medicine (13) to a patient in a nursing home or home for the aged. These visits are limited to a maximum of 3 per patient per month and are intended for use after the first two subsequent visits (W133) have been rendered in the same calendar month. Per , a subsequent visit is any routine assessment following admission. Visits for acute intercurrent illness should be claimed using W121. If this service is rendered in conjunction with a special visit (e.g., an emergency), it must be claimed using the appropriate 'A' prefix assessment and special visit premiums. This service is included in the monthly management fee W010 if claimed for the same month.
When to Use
- Use W138 for the third or subsequent routine visit to a nursing home patient within a single calendar month after W133 has been billed twice.
- Use this code for routine follow-up assessments of chronic conditions in long-term care when the patient is not experiencing an acute intercurrent illness.
- Apply this code when performing a routine visit to a patient in a nursing home or home for the aged where a monthly management fee (W010) is not being claimed.
Common Pitfalls
- Billing W138 in the same month as W010 will result in an automatic rejection, as the management fee is intended to cover all routine subsequent visits.
- Claiming W138 for an acute intercurrent illness instead of the appropriate W121 code is a common audit trigger for incorrect service classification.
- Billing W138 before the two allowed W133 visits have been exhausted will lead to payment denials or recovery during reconciliation.
Billing Tips
- Track your monthly visit count per patient carefully to ensure you transition from W133 to W138 only after the second visit of the month.
- If you are called to the facility for an acute, unexpected change in patient status, prioritize W121 over W138 to accurately reflect the complexity of the encounter.
Effective: June 1, 2025
Consultations and Visits
Internal and Occupational Medicine (13)
Assessment
Hospital and Institutional Consultations and Assessments
In addition to standard medical record-keeping, when a physician is already in the institution and is asked to assess one of his/her own in-patients, the subsequent visit listings ('W' prefix) apply.
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