W314 – General re-assessment of patient in nursing home
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A general re-assessment of a patient in a nursing home includes all the services of a general assessment, except for the patient's history, which need not include all details from the original assessment. As per the definition of a general assessment on , this service requires a full history of the presenting complaint and, except where not medically indicated or refused, an examination of all body parts and systems. It also includes all common and specific elements of an assessment as outlined in the Schedule of Benefits (-). This service is intended for non-emergency in-patient services in a long-term care setting.
When to Use
- Use W314 when performing a comprehensive periodic re-assessment of a nursing home resident that exceeds the scope of a routine W004 visit.
- Use this code for a scheduled, non-emergency general assessment of a patient's status when the W010 monthly management fee is not being claimed for that specific month.
Common Pitfalls
- Claiming W314 in the same month as W010 is a common audit trigger, as W314 is considered a component of the monthly management fee.
- Exceeding the limit of two W314 claims per 12-month period will result in automatic payment adjustments to a lower assessment fee.
- Failing to document a physical examination of all body systems as required by the GP21 definition will lead to clawbacks during an audit.
Billing Tips
- Ensure the date of service is at least six months after a periodic health visit to comply with the Nursing Homes Act requirements.
- If the patient requires a focused assessment rather than a general re-assessment, bill W004 instead to avoid unnecessary utilization of your W314 annual limit.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
A record of the patient's history of the presenting complaint.
A record of the physical examination of one or more systems.
The medical record must establish that an insured service was provided, the service claimed is the service that was rendered, and the service was medically necessary.
*May only be claimed 6 months after Periodic health visit (as per the Nursing Homes Act).
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