W311 – Additional subsequent visits - chronic care or convalescent hospital
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Represents an additional subsequent visit to a patient in a chronic care or convalescent hospital. A subsequent visit is a routine assessment following the patient's admission (see ). This service is eligible for payment after the first 4 subsequent visits for the same patient by the same physician in a calendar month have been rendered and claimed under W312. A maximum of 6 additional visits may be claimed per month using W311. This service applies to patients in Chronic Care Hospitals, Convalescent Hospitals, and designated chronic or convalescent care beds in hospitals, but not to patients in designated palliative care beds. For general rules on long-term care subsequent visits, see .
When to Use
- Use W311 for the 5th through 10th subsequent visits for a chronic or convalescent patient within a single calendar month.
- Use this code only after the initial 4 visits have been billed using W312, as W311 is strictly for additional visits beyond that threshold.
Common Pitfalls
- Billing W311 for patients in palliative care beds, which is prohibited; use W982 for those specific patients instead.
- Attempting to bill W311 for intercurrent illnesses; these must be billed under W121 regardless of the number of previous visits.
- Exceeding the monthly limit of 6 claims for W311, which will result in automated rejections by the Ministry.
Billing Tips
- Track your monthly visit count per patient carefully to ensure W312 is used for the first 4 visits before switching to W311 for subsequent encounters.
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