W310 – Limited consultation
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation is a consultation which is less demanding and, in terms of time, normally requires substantially less of the physician's time than a full consultation. Otherwise, a limited consultation has the same requirements as a full consultation as defined on page of the Schedule. A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon, requiring the consultant to prepare a written report with findings, opinions, and recommendations to the referring practitioner. 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 W310 for a focused assessment in a long-term care or chronic care facility when the complexity does not warrant the full scope of a W510 consultation.
- Use this code when providing a formal opinion on a specific, limited clinical question for a patient already residing in a designated chronic or convalescent care bed.
Common Pitfalls
- Billing W310 for patients in acute care hospital beds, as this code is strictly restricted to chronic care, convalescent, or long-term care settings.
- Failing to maintain a written referral request from the referring practitioner, which is a mandatory audit requirement for all W-prefix consultations.
- Attempting to bill W310 alongside special visit premiums, which are explicitly prohibited for W-prefix institutional codes.
Billing Tips
- Ensure the written referral explicitly states the clinical question or service required, as a generic 'please see' note may be insufficient to support the consultation fee upon audit.
- If the patient has been seen for the same diagnosis within the last 12 months, ensure the documentation clearly justifies the necessity of a new consultation to avoid automatic downgrades to a repeat assessment fee.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician's medical record. In a hospital or long-term care institution with common medical records, the written request may be on the common record.
The request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number.
The written request must set out the information relevant to the referral and specify the service(s) required.
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