W224 – Genetics - Nursing home or home for the aged - first 2 subsequent visits per patient per month
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit is a routine assessment by a Genetics specialist for a patient in a nursing home or home for the aged, following the patient's admission. The service includes all the specific elements of an assessment as outlined in the Schedule of Benefits (see ). This code specifically covers the first two subsequent visits rendered to a patient in a calendar month. As per , these services apply to non-emergency in-patient services in long-term care institutions. For additional visits due to an acute intercurrent illness, W121 should be used.
When to Use
- Use W224 for the first two routine follow-up assessments per calendar month for a genetics patient residing in a nursing home or home for the aged.
- Use W224 when providing non-urgent, ongoing management of a genetic condition where no acute intercurrent illness is present.
Common Pitfalls
- Billing W224 for an acute intercurrent illness, which should instead be billed under W121 to ensure appropriate compensation.
- Attempting to claim Special Visit Premiums (e.g., travel or after-hours) with W224, which is strictly prohibited under GP65.
- Exceeding the two-visit monthly limit for W224; any subsequent visits beyond the first two must be billed using W228.
Billing Tips
- Ensure your billing software tracks the monthly count of W224 visits per patient to automatically switch to W228 for the third, fourth, and fifth visits.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
The medical record must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary, as per .
As per , all assessments must include a direct physical encounter with the patient, history taking, physical examination, and documentation of advice and arrangements for follow-up care.
See General Preamble
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