W255 – Limited consultation
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation rendered by a specialist in Endocrinology & Metabolism (15) for a patient in a long-term care institution (e.g., chronic care hospital, nursing home). A limited consultation is defined in as being less demanding and normally requiring substantially less of the physician's time than a full consultation. However, it must still meet all the requirements of a consultation as defined in , which includes a written request from a referring physician, nurse practitioner, or dental surgeon.
When to Use
- Use W255 when an Endocrinologist provides a focused, limited consultation for a patient in a long-term care facility, such as a nursing home, following a formal written request.
- Use this code for a specific, time-limited endocrine evaluation that does not meet the complexity requirements of a full consultation (W155), provided the patient is in a chronic care or institutional setting.
Common Pitfalls
- Billing W255 for a patient in an acute care hospital setting is a common error; use the appropriate 'A' prefix consultation codes for acute care facilities instead.
- Failing to document a formal written request from the referring physician or nurse practitioner will lead to a clawback, as W255 strictly requires a referral per GP16.
- Billing W255 when the service is actually a follow-up assessment (W156) rather than a new consultation; ensure the service meets the definition of a consultation (new clinical problem or request for a new opinion).
Billing Tips
- Always verify that the patient's location is classified as a long-term care institution, as the 'W' prefix is specific to these settings and differs from standard hospital billing.
- If the endocrine service is urgent and requires a special visit, do not use W255; instead, bill the appropriate 'A' prefix assessment code combined with the applicable Special Visit Premium from GP73.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
The request identifies the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.