W313 – First 2 subsequent visits per patient per month in nursing home or home for the aged
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
W313 is for the first two subsequent visits per patient per month in a nursing home or home for the aged. A subsequent visit, as defined in , is any routine assessment following the patient's admission to a long-term care institution. As an assessment, it requires a direct physical encounter with the patient, including a history and physical examination appropriate to the patient's condition ().
When to Use
- Use W313 for routine follow-up assessments in a long-term care facility when you are not the primary physician claiming the W010 monthly management fee.
- Use W313 for the first two subsequent visits per month when providing episodic care to a patient whose primary physician is not currently claiming the W010 fee.
Common Pitfalls
- Claiming W313 alongside W010 will result in an automatic rejection, as W313 is considered a component of the monthly management fee.
- Attempting to add a special visit premium (e.g., K962 or K963) to W313 will lead to claim rejection, as premiums are not payable with 'W' prefix codes.
- Exceeding the limit of two W313 claims per patient per month will trigger a rejection; subsequent visits beyond the second must be billed using W318.
Billing Tips
- If you are the primary physician responsible for the patient's ongoing care, bill W010 instead of W313 to ensure you are compensated for the comprehensive monthly management of the patient.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
All insured services must be documented in the patient's medical record to establish that the service was provided, is the service for which the account is submitted, and was medically necessary ().
As an assessment, this service requires documentation of a direct physical encounter with the patient, including a patient history and physical examination appropriate for a routine follow-up visit ().
Subsequent visits are subject to the limits described with each individual service as found under the applicable specialty ().
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.