W172 – First 4 subsequent visits per patient per month in chronic care or convalescent hospital
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit for a patient admitted to a long-term care institution, specifically a chronic care or convalescent hospital, rendered by a physician in Vascular Surgery (17). As per , a subsequent visit is any routine assessment following the patient's admission. This code applies to the first four subsequent visits per patient, per month. For emergency calls and other special visits, General Listings ('A' prefix codes) and Special Visit Premiums are applicable as described in to .
When to Use
- Use W172 for routine, non-urgent follow-up assessments of a vascular surgery patient admitted to a chronic care or convalescent facility.
- Use this code for the first four visits of the month; once the fourth visit is reached, subsequent routine visits must be billed under W171.
Common Pitfalls
- Billing W172 for an acute intercurrent illness; use W121 instead, which is payable regardless of the monthly W172 limit.
- Attempting to attach Special Visit Premiums to W172, which will result in a rejection as these are only applicable to 'A' prefix codes.
- Billing W172 when acting as the MRP for a Nursing Home patient, as these visits are already included in the W010 monthly management fee.
Billing Tips
- Track your monthly visit count per patient carefully to ensure you switch to W171 after the fourth visit to avoid manual adjustments or claim rejections.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
As with all assessments, this service requires a direct physical encounter with the patient, including taking a patient history and performing a physical examination, and must be documented in the patient's medical record as per and .
NON-EMERGENCY LONG-TERM CARE IN-PATIENT SERVICES: Includes Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, designated chronic or convalescent care beds in hospitals and nursing homes or homes for the aged, other than patients in designated palliative care beds. For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
Subsequent visits (see General Preamble )
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