W175 – Not found
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A vascular surgery consultation for a non-emergency patient in a Long-Term Care Institution. These services apply to patients in chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent care beds in hospitals, excluding patients in designated palliative care beds. According to the definition on page , a consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon, requiring the consultant to prepare a written report with findings, opinions, and recommendations for the referring practitioner. For emergency calls and other special visits, General Listings ('A' prefix codes) and Special Visit Premiums must be used instead.
When to Use
- Use W175 for a non-urgent vascular surgery assessment of a patient residing in a long-term care facility or chronic care bed when a formal written referral is present.
- Use this code for elective vascular consultations in a nursing home setting where the patient does not meet the criteria for an emergency 'A' prefix code or Special Visit Premium.
Common Pitfalls
- Billing W175 when the referral was requested after the patient was already seen; this must be downgraded to a subsequent visit code as it fails the consultation definition.
- Attempting to claim Special Visit Premiums with W175; this code is strictly for non-emergency services and is ineligible for any 'A' prefix premium add-ons.
- Failing to document the specific written request from the referring practitioner in the chart, which triggers an automatic audit rejection for the consultation fee.
Billing Tips
- Ensure the referring practitioner's name and billing number are clearly documented in your clinical note to satisfy the GP16 requirements for a valid consultation.
- If the patient is in a palliative care designated bed, W175 is excluded; bill an appropriate 'A' prefix visit code instead.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
A copy of the written request for the consultation, signed by the referring practitioner, must be kept in the patient's medical record. If in a facility with a common medical record, the request may be on that record.
The request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number.
The written request must specify the service(s) required and include relevant information for the referral.
The consultant must prepare a written report including findings, opinions, and recommendations for the referring practitioner.
The referring practitioner must determine the medical necessity of multiple consultation requests by a patient for the same condition to different physicians in the same specialty.
The consultation limits are applicable to all consultations, including time-based and age-specific consultation services (e.g. special, extended and comprehensive consultations) but not repeat consultations.
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