W188 – Subsequent visits per month (maximum of 3 per patient per month) in a nursing home or home for the aged
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service represents a routine subsequent assessment by a Neurologist (specialty 18) for a patient in a nursing home or home for the aged, as listed on page . As defined in the General Preamble (), a subsequent visit is any routine assessment following the patient's admission. This service is limited to a maximum of 3 visits per patient per month.
When to Use
- Use W188 for routine follow-up assessments of chronic neurological conditions for patients residing in a nursing home or home for the aged.
- Use this code for stable patients when the visit does not meet the criteria for an acute intercurrent illness as defined for W121.
Common Pitfalls
- Billing W188 in the same month as W010 will result in an automatic rejection, as W188 is considered a component of the monthly management fee.
- Exceeding the maximum of 3 visits per patient per month will trigger a rejection; any visits beyond this limit must be medically necessary and billed under a different code if applicable.
- Billing W188 for patients in designated palliative care beds is ineligible and will be clawed back during an audit.
Billing Tips
- If the patient develops an acute intercurrent illness, bill W121 instead of W188 to bypass the 3-visit monthly limit and ensure payment for the acute episode.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
This service applies to patients in nursing homes or homes for the aged, other than patients in designated palliative care beds.
Claims for these subsequent visits are subject to the limits described with each individual service as found under the applicable specialty in the Consultations and Visits section.
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