W260 – Not found
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A special paediatric consultation rendered by a paediatrician for a patient in a non-emergency, long-term care in-patient facility. These facilities include chronic care hospitals, convalescent hospitals, nursing homes, and homes for the aged. This service is subject to the same conditions as A260 (as per page A173). As a consultation, it requires a written request from a referring practitioner due to the complexity, seriousness, or obscurity of the case, and the consultant must provide a written report back to the referring practitioner as per rules on .
When to Use
- Use W260 for a formal paediatric consultation requested by a referring physician for a patient residing in a chronic care hospital or nursing home.
- Use this code when the patient's clinical complexity requires a comprehensive specialist assessment that exceeds the scope of a routine follow-up visit in an institutional setting.
Common Pitfalls
- Do not bill W260 with special visit premiums; if you are attending an institution for an urgent/non-elective visit, use A260 with the appropriate Table IV premium instead.
- Failure to maintain a written referral request from a physician or nurse practitioner in the patient's chart will result in a clawback during audit as this is a mandatory consultation requirement.
- Billing W260 for a patient who is not in a designated long-term care or chronic care facility is an invalid use of the 'W' prefix and will lead to rejection.
Billing Tips
- Always apply the appropriate age-based premium (e.g., under 16 years) to the W260 base fee to ensure you are receiving the full specialist compensation allowed under the Schedule of Benefits.
- Ensure your written report to the referring practitioner is dated and clearly outlines your findings and recommendations to satisfy the documentation requirements for a valid consultation.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Special paediatric consultation
Consultations, Hospital and Institutional Consultations and Assessments
A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician's medical record (or on the common medical record).
The request must identify the consultant by name, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identify the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
A written report of findings, opinions, and recommendations must be provided to the referring practitioner.
Applicable to newborns, infants, children, and adolescents as per the Paediatrics specialty context.
Subject to the same conditions as A260.
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