W173 – Subsequent visits - nursing home or home for the aged - first 2 per month
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit by a vascular surgeon for a patient in a nursing home or home for the aged. This fee code applies to the first two subsequent visits per patient, per month. A subsequent visit is any routine assessment following the patient's admission to a long-term care institution, as defined in the General Preamble (). As an assessment, this service includes the specific elements of assessments () in addition to the common elements (, ) of all insured services. For emergency calls and other special visits to in-patients, use General Listings ('A' prefix codes) and Special Visit Premiums where applicable (see to ).
When to Use
- Use W173 for the first two routine follow-up assessments of a vascular patient residing in a long-term care facility within a calendar month.
- Use W173 when managing chronic vascular conditions like venous stasis ulcers or peripheral arterial disease in a nursing home setting, provided the patient is not currently under a W010 monthly management plan.
Common Pitfalls
- Billing W173 in the same month as W010 will result in automatic rejection or clawback, as routine visits are considered inclusive of the management fee.
- Attempting to bill W173 for more than two visits per month will lead to rejection; subsequent visits beyond the first two must be billed using W178.
Billing Tips
- Ensure your billing software tracks the monthly count of W173 claims to prevent exceeding the two-visit limit, as the system will automatically reject the third claim.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
See General Preamble for rules regarding subsequent visits in Long-Term Care Institutions.
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
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