W272 – Admission assessment - Type 1
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Type 1 admission assessment is a general assessment rendered to a patient on admission to a long-term care institution. Long-Term Care In-Patient Services includes Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, and designated chronic or convalescent care beds in hospitals, other than for patients in designated palliative care beds. As a general assessment, it requires a full history (including presenting complaint, family, past medical, and social history, and a functional inquiry of all body systems) and a comprehensive physical examination of all body parts and systems, unless not medically indicated or refused. It may include a detailed examination of one or more parts or systems. For emergency calls and special visits to in-patients, use General Listings (A prefix codes) and Premiums.
When to Use
- Use W272 when performing the initial comprehensive admission assessment for a patient newly admitted to a nursing home or home for the aged.
- Use this code for the first formal assessment when a patient is transferred into a designated chronic care bed, provided it is not a palliative care bed.
Common Pitfalls
- Billing W272 in the same month as the monthly management fee W010 will result in an automatic rejection or clawback.
- Claiming W272 after having already billed a consultation or general assessment for the same patient immediately prior to admission will trigger a mandatory fee adjustment to a lower value.
- Using W272 for patients in designated palliative care beds is incorrect; these should be billed using the appropriate palliative care codes.
Billing Tips
- Ensure the clinical note explicitly documents the comprehensive nature of the history and physical exam to satisfy the 'general assessment' requirement, as this is the primary target for post-payment audits.
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