W161 – Additional Subsequent Visits (Maximum of 6 per Patient per Month) per Visit
OHIP Neurology Code — Nephrology (16) · Schedule of Benefits
An additional subsequent visit for a patient in a chronic care or convalescent hospital. As defined in , this is a routine assessment following the patient's admission. This service is for visits that occur after the first four subsequent visits in a month have been provided (claimed as W162). A maximum of 6 total routine subsequent visits are payable per patient per month. This service includes all the common and specific elements of an assessment as defined in the Schedule of Benefits (see , ). Visits for acute intercurrent illness should be claimed as W121 and are not subject to this monthly limit.
When to Use
- Use W161 for the 5th and 6th routine chronic care follow-up visits in a single calendar month after the initial four W162 claims are exhausted.
- Use this code for routine monitoring of chronic conditions in a convalescent hospital setting when no acute intercurrent illness is present.
Common Pitfalls
- Billing W161 for an acute intercurrent illness; these must be claimed as W121 to avoid the monthly limit and ensure appropriate payment.
- Exceeding the maximum of 6 total routine subsequent visits per month, which will trigger automatic rejections from the Ministry.
- Attempting to add special visit premiums to W161 claims, which is strictly prohibited for routine rounds in long-term care institutions.
Billing Tips
- Track your monthly visit count carefully, as W162 is used for the first four visits and W161 is reserved exclusively for the fifth and sixth visits.
Effective: June 1, 2025
Consultations and Visits
Nephrology (16)
Assessment
Hospital and Institutional Consultations and Assessments
All insured services must be documented in appropriate medical records, establishing that an insured service was provided, the service claimed is the service rendered, and the service was medically necessary.
*May only be claimed 6 months after Periodic health visit (as per the Nursing Homes Act).
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