W252 – Admission assessment - Type 1
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A W252 Type 1 admission assessment is defined as a general assessment rendered to a patient on admission to a long-term care institution (:). Service Context: This service applies to non-emergency in-patient services 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 (:). Required Elements: As a general assessment, this service requires a full history and a comprehensive physical examination. According to :, this includes: - A full history, including the presenting complaint, family medical history, past medical history, social history, and a functional inquiry into all body parts and systems. - An examination of all body parts and systems (except for breast, genital or rectal examination where not medically indicated or refused). - May include a detailed examination of one or more parts or systems. This service also includes the specific elements of all assessments as outlined on : and the common elements of all insured services (:, :).
When to Use
- Use W252 for the initial comprehensive admission assessment when a patient is first admitted to a long-term care facility or chronic care bed.
- Use this code when the patient has not received a prior consultation or general assessment by the same physician for the same condition immediately preceding the admission.
Common Pitfalls
- Billing W252 when the patient is in a designated palliative care bed, which is explicitly excluded from this code's coverage.
- Submitting W252 after performing a consultation or general assessment for the same patient/condition, which triggers an automatic fee adjustment to a lower rate.
- Failing to document a full systems review or physical examination, as W252 requires the same comprehensive rigor as a standard general assessment (A007/A008).
Billing Tips
- Ensure the admission date matches the date of service, as W252 is strictly tied to the initial entry into the facility.
- If you have already performed a consultation (e.g., A005) for the patient prior to the admission, be prepared for the W252 claim to be automatically adjusted to the lower 're-assessment' fee level.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
A full history, including the presenting complaint, family medical history, past medical history, social history, and a functional inquiry into all body parts and systems.
An examination of all body parts and systems (except for breast, genital or rectal examination where not medically indicated or refused).
May include a detailed examination of one or more parts or systems.
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