W261 – Additional subsequent visits per month (maximum 6 per patient per month) - Chronic care or convalescent hospital
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A routine assessment following a patient's admission to a long-term care institution, such as a chronic care hospital, convalescent hospital, nursing home, or home for the aged. This service is for additional subsequent visits after the first four visits per month have been billed under W262. As an assessment, this service includes the required specific elements such as a direct physical encounter with the patient, taking a relevant history, performing a physical examination, providing advice, and making arrangements for follow-up care as needed. See the General Preamble (, ) for a full list of constituent elements.
When to Use
- Use W261 only after you have already billed four instances of W262 for the same patient within the same calendar month.
- Use this code for routine follow-up assessments in a chronic care or convalescent facility when the patient is stable and does not require management of an acute intercurrent illness.
Common Pitfalls
- Billing W261 for an acute intercurrent illness; you must use W121 for acute issues regardless of how many W262 visits have been claimed.
- Exceeding the combined monthly limit of six visits (W262 + W261) per patient, which will result in automatic claim rejections.
- Attempting to bill W261 before exhausting the four-visit allotment of W262, as the system validates the sequence of these codes.
Billing Tips
- Track your monthly visit count for chronic care patients carefully to ensure you switch from W262 to W261 precisely on the fifth visit of the month.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
As with all services described as assessments, a direct physical encounter with the patient is required and must be documented in the patient's medical record. ()
In surgical cases requiring medical direction, standard in-hospital medical fees are to be claimed in addition to the surgical fee. This includes all operations on babies under one year of age, and all other older children who require medical supervision.
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