W190 – Special psychiatric consultation
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A special psychiatric consultation rendered to a patient in a long-term care institution, including Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, and Homes for the Aged. This service is subject to the same conditions as A190. As a consultation, it requires a written request from a referring physician, nurse practitioner, or dental surgeon. The consultant must perform a comprehensive assessment, including a review of all relevant data, and provide a written report with findings, opinions, and recommendations to the referring practitioner. The 'special' designation, similar to a A935 special surgical consultation, implies the physician must devote at least ninety minutes exclusively to the consultation with the patient before a psychiatric consultation extension (K630) can be billed (see ). The service includes all common and specific elements of an assessment as outlined in the Schedule (see -).
When to Use
- Use W190 for a comprehensive psychiatric consultation performed in a long-term care facility, nursing home, or chronic care hospital that requires at least 90 minutes of direct patient assessment.
- Choose W190 over A190 when the complexity of the psychiatric case necessitates a 'special' designation due to the extensive time commitment required for the assessment.
Common Pitfalls
- Billing W190 without a formal, written referral request from the attending practitioner, which is a mandatory requirement for all consultation codes.
- Failing to document the start and end times of the 90-minute assessment, which is required to justify the 'special' designation and is a common trigger for audit adjustments.
- Attempting to bill K001 (detention) on the same day as W190, which is strictly prohibited by the Schedule of Benefits.
Billing Tips
- Ensure your written report to the referring practitioner explicitly details the complexity of the case to support the necessity of a 90-minute special consultation.
- If the assessment time is less than 90 minutes, you must bill A190 instead of W190 to avoid a payment adjustment to a lower assessment fee.
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 consulting physician's medical record (or on the common medical record in a hospital/LTC setting).
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 set out the information relevant to the referral and specify the service(s) required.
The consultant must prepare a written report (including findings, opinions, and recommendations) to the referring practitioner.
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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