W231 – Neuro-Ophthalmology Consultation
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A neuro-ophthalmology consultation provided to a non-emergency in-patient in a long-term care institution (Chronic Care Hospital, Convalescent Hospital, Nursing Home, Home for the Aged, or designated chronic/convalescent care beds). This service is subject to the same conditions as a general listings neuro-ophthalmology consultation (A231). As per the definition of a consultation on page , this service requires a written request from a referring physician, nurse practitioner, or dental surgeon. The consultant must perform an appropriate assessment, including a review of all relevant data, and provide a written report with findings, opinions, and recommendations to the referring practitioner. For emergency calls to these facilities, 'A' prefix General Listings and special visit premiums should be used instead.
When to Use
- Use W231 for non-emergency neuro-ophthalmological assessments of patients admitted to a long-term care facility, such as a nursing home or chronic care hospital.
- Use this code when the patient is already an established resident or inpatient in a chronic care setting and requires a formal consultation for a new or ongoing neuro-ophthalmological issue.
Common Pitfalls
- Billing W231 for emergency neuro-ophthalmological assessments in a long-term care facility; these must be billed using A231 plus the appropriate special visit premiums.
- Failing to ensure a formal written request from the referring physician or nurse practitioner exists, which will lead to a reduction to a lower assessment fee upon audit.
- Confusing W231 with A231; A231 is strictly for non-institutional settings or acute hospital consultations, whereas W231 is specifically for the defined long-term care institutional list.
Billing Tips
- Ensure your written report is sent directly to the referring practitioner, as the consultation fee is contingent upon the delivery of these findings and recommendations.
- Verify the facility's designation; if the patient is in a palliative care bed, W231 may not apply, and you should confirm the correct billing code based on the specific facility's OHIP status.
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 is required to prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon.
Subject to the same conditions as A231.
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