W277 – Admission assessment - Type 3
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Type 3 admission assessment is a general re-assessment of a patient who is re-admitted to the long-term care institution after a minimum 3 day stay in another institution (see ). A general re-assessment includes all the services listed for a general assessment, with the exception of the patient's history, which need not include all the details already obtained in the original assessment (see ).
When to Use
- Use W277 when a patient returns to your long-term care facility following a hospital admission of at least 3 days to perform the required re-assessment.
- Select W277 instead of W272 or W274 when the patient has been discharged from an acute care setting and requires a formal re-evaluation of their clinical status upon return to the facility.
Common Pitfalls
- Billing W277 in the same calendar month as the W010 Monthly Management Fee will result in a rejection, as the assessment is considered inclusive of the management fee.
- Claiming W277 for patients who were away from the facility for fewer than 3 days is a common audit trigger; ensure the hospital stay duration meets the minimum threshold before submission.
Billing Tips
- Ensure your documentation clearly notes the discharge date from the hospital and the admission date to the facility to substantiate the 3-day requirement during a Ministry audit.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
In accordance with the Health Insurance Act, the medical record must establish that: an insured service was provided; the service for which the account is submitted is the service that was rendered; and the service was medically necessary (see ).
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