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W222
W222 – Genetics subsequent visits - chronic care or convalescent hospital - first 4 per patient per month
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service represents one of the first four subsequent visits in a calendar month by a specialist in Genetics (22) to a patient in a chronic care hospital or convalescent hospital. A subsequent visit is defined as a routine assessment following the patient's admission to a long-term care institution (see ). As an assessment, it includes the specific elements described in , such as a direct physical encounter with the patient, history taking, and physical examination. Additional subsequent visits beyond the fourth per month should be claimed using W221.
When to Use
- Use W222 for routine, scheduled follow-up assessments of a patient admitted to a chronic care or convalescent facility within the first four visits of the calendar month.
- Use W222 when managing chronic genetic conditions in an institutional setting where the patient does not meet the criteria for an acute intercurrent illness assessment.
Common Pitfalls
- Billing W222 in the same month as W010 will trigger an automatic rejection, as the monthly management fee is intended to cover these subsequent visits.
- Attempting to attach special visit premiums to W222 will result in a rejection, as these are routine visits and not eligible for non-elective premiums.
- Exceeding the four-visit limit per month using W222 instead of switching to W221 for the fifth visit and beyond will lead to payment adjustments.
Billing Tips
- Ensure your billing software tracks the monthly count of W222 claims to automatically transition to W221 once the fifth visit occurs in a calendar month.
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