W160 – Comprehensive Nephrology Consultation
OHIP Neurology Code — Nephrology (16) · Schedule of Benefits
A comprehensive nephrology consultation for a patient in a non-emergency long-term care in-patient service setting. Eligible locations include Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, and designated chronic or convalescent care beds in hospitals, other than patients in designated palliative care beds. This service is subject to the same conditions as A160. As a consultation, it requires a written request from a referring physician, nurse practitioner, or dental surgeon who requests the opinion of a specialist because of the complexity, seriousness, or obscurity of the case.
When to Use
- Use W160 for the initial nephrology evaluation of a patient residing in a nursing home or chronic care facility when requested by the primary care provider for a complex renal issue.
- Use W160 when performing a comprehensive consultation for a patient in a convalescent care bed, provided the patient is not in a designated palliative care bed.
Common Pitfalls
- Failure to document start and stop times in the patient record will result in an automatic adjustment to a lower assessment fee, as W160 follows the same strict documentation requirements as A160.
- Billing W160 for a patient in a palliative care bed is a common audit trigger; ensure the facility bed status is confirmed as chronic or convalescent before submission.
- Billing a consultation and a psychotherapy service on the same day for the same patient will cause a rejection unless you can demonstrate two distinct, unrelated diagnoses.
Billing Tips
- Always ensure the written referral request is clearly identifiable in the chart, as the Ministry requires proof of the specific request for a specialist opinion due to case complexity.
- When visiting a long-term care institution for a W160, remember to append the appropriate W960-W963 travel premium if the visit meets the criteria for a special visit.
Effective: June 1, 2025
Consultations and Visits
Nephrology (16)
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
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, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
The request identifies the consultant by name, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
For A160, the start and stop times must be recorded in the patient’s permanent medical record or the amount payable for the service will be adjusted to a lesser paying fee.
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
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