W274 – Admission assessment - Type 2
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Type 2 admission assessment occurs when the admitting physician makes an initial visit to assess the condition of the patient following admission and has previously rendered a consultation, general assessment or general re-assessment of the patient prior to admission. 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. As an assessment, it includes all specific elements outlined in the Schedule of Benefits on page , such as a direct physical encounter, history taking, and making arrangements for related care.
When to Use
- Use W274 when you have already performed a consultation or general assessment on the patient in the community prior to their admission to a chronic care or convalescent facility.
- Use this code for the initial admission assessment in a nursing home or home for the aged when a prior assessment has been documented in the patient's record.
Common Pitfalls
- Claiming W274 in the same month as the monthly management fee W010 will result in a rejection, as the admission assessment is considered bundled into the monthly fee.
- Billing W274 when no prior consultation or general assessment exists will lead to an audit risk, as the code specifically requires a pre-admission assessment history.
Billing Tips
- Ensure your billing software or manual claim reflects the prior assessment date to justify the use of W274 over the higher-valued W272.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
The medical record must document the visit and support that the service was for an admission assessment.
The patient's permanent medical record must be maintained in accordance with the requirements outlined in the Health Insurance Act (see ).
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