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W257
W257 – Admission assessment - Type 3
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Type 3 admission assessment is a general re-assessment of a patient who is re-admitted to the long-term care institution after a minimum 3 day stay in another institution. As a general re-assessment, it includes all the services listed for a general assessment, with the exception of the patient's history, which need not include all the details already obtained in the original assessment. See and for details.
When to Use
- Use W257 when a patient returns to your long-term care facility following a hospital admission of at least 72 hours.
- Use this code for the required comprehensive re-assessment when the patient's clinical status has changed significantly during their absence.
Common Pitfalls
- Claiming W257 in the same month as W010 will result in an automatic rejection, as the admission assessment is included in the monthly management fee.
- Attempting to bill W257 alongside Special Visit Premiums is prohibited; if the assessment occurs after hours, use the appropriate 'A' prefix code from the General Listings instead.
- Failing to document the minimum 3-day duration of the external facility stay will lead to audit recovery, as this is the primary eligibility requirement.
Billing Tips
- Ensure your documentation explicitly notes the discharge date from the external institution to verify the 3-day threshold required for W257 eligibility.
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