W163 – Subsequent Visit - Nursing Home or Home for the Aged
OHIP Neurology Code — Nephrology (16) · Schedule of Benefits
A subsequent visit is a routine assessment following the patient's admission to a long-term care institution, such as a nursing home or home for the aged, rendered by a physician with a specialty in Nephrology (16). This service constitutes one of the first two subsequent visits to the patient in a calendar month. See the General Preamble () for the full definition and requirements for a subsequent visit.
When to Use
- Use W163 for the first or second routine follow-up visit of the month when you are not the Most Responsible Physician (MRP) and therefore cannot claim the monthly management fee W010.
- Use this code for nephrology-specific assessments in a long-term care facility when the patient does not meet the criteria for a complex chronic disease management code.
Common Pitfalls
- Billing W163 in the same month as W010 will trigger an automatic rejection, as the monthly management fee is intended to cover all routine visits by the MRP.
- Claiming W163 more than twice in a single calendar month is a common audit trigger; subsequent visits beyond the second must be billed using different assessment codes if applicable.
Billing Tips
- Ensure your billing software is configured to track the count of W163 claims per patient per month to avoid exceeding the two-visit limit per calendar month.
Effective: June 1, 2025
Consultations and Visits
Nephrology (16)
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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