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W184

W184General re-assessment of patient in nursing home

OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits

A general re-assessment includes all the services listed for a general assessment, with the exception of the patient's history, which need not include all the details already obtained in the original assessment. In addition to the - common elements of all insured services, all assessments include the following specific elements: - A direct physical encounter with the patient including taking a patient history and performing a physical examination. - Other inquiry (including taking a patient history), carried out to arrive at an opinion as to the nature of the patient's condition. - Performing any procedure(s) during the same encounter as the physical examination, unless the procedure(s) is(are) separately listed in the Schedule and an amount is payable for the procedure in conjunction with an assessment. - Making arrangements for any related assessments, procedures, or therapy, and/or interpreting results. - Making arrangements for follow-up care. - Discussion with, and providing advice and information, including prescribing therapy to the patient or the patient's representative. - When medically indicated, monitoring the condition of the patient and intervening, until the next insured service is provided. - Providing premises, equipment, supplies, and personnel for the specific elements of the service except for any aspect(s) that is (are) performed in a hospital or nursing home.

When to Use

  • Use W184 for the routine periodic re-assessment of a nursing home resident when the patient does not meet the criteria for a specific acute illness visit.
  • Select W184 when performing the mandatory periodic review required by the Nursing Homes Act, provided it occurs at least 6 months after the last periodic health visit.

Common Pitfalls

  • Billing W184 within 6 months of a periodic health visit will trigger an automatic rejection as it violates the Nursing Homes Act frequency restrictions.
  • Claiming W184 for an acute issue when a specific visit code (e.g., A007) would provide higher compensation and more accurately reflect the nature of the encounter.

Billing Tips

  • Ensure the nursing home chart clearly distinguishes the W184 re-assessment from acute care visits to withstand audits regarding the frequency of periodic reviews.
Provider Fee$0.00
Specialist Fee$20.60

Effective: June 1, 2025

Category

A. Consultations and Visits

Subcategory

CONSULTATIONS AND VISITS

Service Type

Assessment

Code Classes

Assessments, Hospital and Institutional Consultations and Assessments

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