W262 – Subsequent visits - first 4 subsequent visits per patient per month - Chronic care or convalescent hospital
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit is a routine assessment following a patient's admission to a long-term care institution, specifically a chronic care or convalescent hospital. As per , this service applies to non-emergency in-patient services. This fee code, W262, is used for the first four subsequent visits per patient per month. For additional subsequent visits within the same month, see W261. The service includes all the specific elements of an assessment as outlined in , such as a direct physical encounter with the patient, history taking, physical examination, arranging for related assessments, and providing advice to the patient or their representative.
When to Use
- Use W262 for the first four routine follow-up assessments per calendar month for patients admitted to a chronic care or convalescent hospital.
- Use W262 when managing stable chronic conditions in a convalescent setting that do not meet the criteria for an acute intercurrent illness visit under W121.
Common Pitfalls
- Billing W262 in the same month as W010 is a common audit trigger, as W010 is intended to be all-inclusive for management in nursing homes.
- Exceeding the four-visit limit per month with W262 will result in rejections; ensure subsequent visits beyond the fourth are billed using W261.
- Attempting to bill W262 for acute intercurrent illnesses instead of using the appropriate W121 code will lead to claims being flagged for incorrect service type.
Billing Tips
- Track your monthly visit count per patient closely to transition from W262 to W261 automatically once the fourth visit threshold is reached.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
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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