W269 – Periodic health visit
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A periodic health visit is performed on a patient, after their second birthday, who presents and reveals no apparent acute physical or mental illness. 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. This service applies to patients in chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent care beds in hospitals, other than patients in designated palliative care beds.
When to Use
- Use W269 for an asymptomatic patient residing in a nursing home or chronic care facility who requires an annual health review.
- Use this code when performing a routine age-appropriate physical examination on a patient aged 2 to 18 years residing in a long-term care setting.
Common Pitfalls
- Billing W269 in the same calendar month as W010 will trigger an automatic rejection, as the periodic health visit is considered inclusive of the monthly management fee.
- Exceeding the limit of one W269 claim per patient per 12-month period per physician will result in a payment adjustment or rejection.
- Attempting to use W269 for acute illness management is incorrect; use appropriate 'A' prefix hospital visit codes for patients presenting with active medical issues.
Billing Tips
- Ensure your documentation explicitly outlines the age-appropriate screening and counseling performed to satisfy the requirement for an intermediate or level 2 assessment.
- Verify the patient's history to confirm no other physician has claimed W269 within the last 365 days to avoid unnecessary claim rejections.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
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.
For paediatric patients after their second birthday and up to age 18.
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