W220 – Special genetic consultation - non-emergency long-term care in-patient
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A special genetic consultation rendered to a patient in a non-emergency long-term care institution setting, as defined in . These settings include chronic care hospitals, convalescent hospitals, nursing homes, and homes for the aged. The service must meet all the requirements for a consultation as outlined in of the Schedule, including a written request from a referring practitioner. The specific conditions for this service are the same as those for billing code A220.
When to Use
- Use W220 when providing a formal genetic consultation for a patient admitted to a chronic care facility or nursing home, provided the referral meets GP16 standards.
- Select W220 instead of A220 when the patient is physically located in a long-term care institution at the time of the service, as defined in GP49.
Common Pitfalls
- Billing W220 after previously claiming K016 or K222 for the same patient will result in a nil payment, as these services are mutually exclusive for the same physician.
- Failure to document a formal written request from the referring practitioner in the patient's chart will lead to a downgrade of the claim to a lesser assessment fee during an audit.
Billing Tips
- Ensure the referral explicitly identifies you by name or specialty and outlines the specific genetic question to satisfy the GP16 documentation requirements for a consultation.
- Apply the appropriate age-based premium to W220 if the patient meets the specific age criteria, as this code is eligible for the specialist consultation premiums.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
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