W259 – Periodic health visit
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A periodic health visit performed on a patient in a long-term care facility (e.g., chronic care hospital, nursing home) who presents with no apparent acute physical or mental illness. As defined in , the service must include an intermediate assessment, a level 2 paediatric assessment or a partial assessment focusing on age and gender appropriate history, physical examination, health screening, and relevant counselling.
When to Use
- Use W259 for the annual physical examination of a long-term care resident who is stable and has no acute physical or mental health concerns.
- Select this code when performing age-appropriate health screening and preventative counseling for a patient in a nursing home or chronic care facility.
Common Pitfalls
- Billing W259 in the same month as the monthly management fee W010 will result in an automatic rejection as the periodic health visit is considered inclusive of the management fee.
- Attempting to bill W154 (general re-assessment) within six months of a W259 claim will trigger a rejection due to the mandatory interval requirement.
Billing Tips
- Ensure the patient is over the age of two, as W259 is strictly restricted to patients who have passed their second birthday.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
All insured services must be documented in appropriate records. The Act requires that the record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
Performed on a patient after their second birthday.
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