W237 – Admission assessment - Type 3
OHIP Neurology Code — INTERNAL AND OCCUPATIONAL MEDICINE (13) · Schedule of Benefits
A Type 3 admission assessment is a general re-assessment of a patient who is re-admitted to a long-term care institution after a minimum 3 day stay in another institution. As per , this service is applicable to patients in chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent care beds in hospitals, excluding patients in designated palliative care beds. A general re-assessment, defined on , includes all the services of a general assessment, but the patient's history does not need to include all the details already obtained in the original assessment.
When to Use
- Use W237 when a patient returns to their long-term care facility following an acute care hospital stay of at least 3 days, provided they do not occupy a designated palliative care bed.
- Use this code for a comprehensive re-assessment that satisfies the GP22 requirements for a general re-assessment, distinguishing it from a standard W232 follow-up visit.
Common Pitfalls
- Billing W237 for patients returning from an acute stay shorter than 3 days, which results in a rejection or audit recovery; use W232 instead.
- Exceeding the limit of two W237 claims per patient per physician in a 12-month period, which triggers an automatic payment adjustment to a lower assessment fee.
- Failing to document a full physical examination of all body systems, which is a mandatory requirement for a general re-assessment under GP22.
Billing Tips
- Ensure the patient's chart clearly notes the duration of the external hospital stay to justify the use of W237 over routine visit codes like W232 or W234.
Effective: June 1, 2025
A. Consultations and Visits
INTERNAL AND OCCUPATIONAL MEDICINE (13)
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
As a general re-assessment, the service must be documented in the patient's medical record, including the elements of a full history (though details from a previous assessment need not be repeated) and an examination of all body parts and systems (, ).
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.