W168 – Subsequent Visit, Nursing Home or Home for the Aged - Nephrology
OHIP Neurology Code — Nephrology (16) · Schedule of Benefits
A subsequent routine assessment by a nephrologist for a patient in a nursing home or home for the aged. As per , a subsequent visit is any routine assessment following the patient's admission to a long-term care institution. This service is limited to a maximum of 3 per patient per month. This visit may only be claimed 6 months after a Periodic Health Visit, as per the Nursing Homes Act.
When to Use
- Use W168 for routine follow-up nephrology assessments in a long-term care facility when the patient does not meet the criteria for W010 monthly management.
- Use this code for medically necessary subsequent visits that occur after the initial consultation and are not part of a global monthly management fee.
Common Pitfalls
- Claiming W168 in the same calendar month as W010 will result in an automatic rejection, as the service is considered inclusive of the monthly management fee.
- Exceeding the maximum limit of 3 claims per patient per month will trigger an audit or rejection for over-servicing.
- Billing W168 within 6 months of a Periodic Health Visit violates the Nursing Homes Act and will lead to recovery during an OHIP audit.
Billing Tips
- Verify the patient's billing history for W010 before submitting W168 to ensure you are not double-billing for the same period of care.
- Ensure the date of service is clearly documented as a subsequent visit to distinguish it from a W163 or other institutional visit codes.
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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