W225 – Consultation - non-emergency long-term care in-patient services
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation service provided by a specialist in Genetics (22). This service is for non-emergency in-patients in a long-term care institution, which includes chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent care beds in hospitals. It requires a written request from a referring practitioner and involves a comprehensive assessment to provide an opinion on a complex, serious, or obscure case, with a written report sent back to the referring source. This service is subject to the general rules for consultations as outlined in the Schedule of Benefits.
When to Use
- Use W225 for a formal genetics consultation requested for a patient residing in a long-term care facility or chronic care bed where the patient is not in an acute emergency state.
- Choose W225 over A225 when the patient is physically located in a chronic care or nursing home setting at the time of the service, as 'W' codes are specific to these institutional environments.
Common Pitfalls
- Billing W225 after previously claiming K016 or K222 for the same patient will result in a zero-dollar payment, as these codes are mutually exclusive.
- Attempting to add special visit premiums to W225 will lead to automatic rejection, as 'W' prefix codes are ineligible for these premiums.
Billing Tips
- Ensure the referring practitioner's name and billing number are clearly documented in the patient's chart to satisfy the mandatory referral requirement for consultation status.
- If you have previously billed a general assessment or consultation for the patient prior to their current admission, be aware that any subsequent admission assessment (e.g., W102) will be downgraded to a lower 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 physician, nurse practitioner or dental surgeon must be kept in the consulting physician's medical record, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
The request identifies the consultant by name, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
The consultant must prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon.
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