W228 – Subsequent genetics visits in nursing home or home for the aged (maximum 3 per patient per month)
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit is a routine assessment performed by a Genetics specialist for a patient in a nursing home or home for the aged, following the admission assessment. This service includes all the specific elements of an assessment as defined in , including a direct physical encounter with the patient, a relevant history and physical examination, making arrangements for related care, and providing advice to the patient or their representative. This service is intended for visits after the first two subsequent visits in a calendar month (billed as W224). Visits for acute intercurrent illness should be claimed using W121. If a non-elective special visit is required, an 'A' prefix assessment code with the appropriate special visit premium must be used instead of this 'W' prefix code, as per rules on .
When to Use
- Use W228 for the third or subsequent routine genetics follow-up visit within a single calendar month for a patient residing in a nursing home.
- Use this code for ongoing monitoring of a genetic condition when the patient's status is stable and does not require the acute intervention associated with W121.
Common Pitfalls
- Billing W228 in the same month as W010 is a common audit trigger, as the monthly management fee already covers routine subsequent visits.
- Claiming W228 for the first or second visit of the month instead of W224 will result in rejection or payment at the incorrect rate.
- Attempting to attach a special visit premium to W228 is invalid; use an 'A' prefix code if the visit is non-elective and requires a premium.
Billing Tips
- Track your monthly visit count per patient carefully to ensure you transition from W224 to W228 only after the second visit of the month has been submitted.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
See General Preamble for rules regarding subsequent visits in Long-Term Care Institutions.
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