W162 – Subsequent Visits - Chronic Care or Convalescent Hospital
OHIP Neurology Code — Nephrology (16) · Schedule of Benefits
A subsequent visit for a patient in a chronic care hospital or convalescent hospital, rendered by a Nephrologist. This service constitutes a routine assessment following the patient's admission to the institution. See General Preamble page for details on non-emergency in-patient services in long-term care institutions. This code is specifically for the first four subsequent visits per patient per month. Additional visits may be claimed using W161.
When to Use
- Use W162 for the first four routine follow-up assessments per month for a Nephrology patient admitted to a chronic care or convalescent hospital bed.
- Use this code when the patient requires a physical encounter that does not meet the criteria for a consultation or a more complex specialized assessment.
Common Pitfalls
- Billing W162 in the same month as the monthly management fee W010 will result in an automatic rejection, as subsequent visits are considered inclusive of the management fee.
- Exceeding the four-visit monthly limit for W162 without switching to W161 for the fifth and sixth visits will trigger claim adjustments or rejections.
- Attempting to claim W162 for patients in acute care beds rather than designated chronic or convalescent care beds is a frequent audit trigger.
Billing Tips
- Track your monthly visit count per patient carefully; once you hit the fifth visit, ensure you switch to W161 to remain compliant with the six-visit monthly maximum for these institutional settings.
Effective: June 1, 2025
Consultations and Visits
Nephrology (16)
Assessment
Hospital and Institutional Consultations and Assessments
As with all assessments, the service requires a direct physical encounter with the patient including taking a patient history, performing a physical examination, providing advice to the patient, and maintaining an appropriate medical record as per the specific elements of assessments (see ).
The fee for this service applies to visits in a chronic care or convalescent hospital.
May only be claimed 6 months after Periodic health visit (as per the Nursing Homes Act).
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