W325 – Limited consultation - Non-Emergency Long-Term Care In-Patient Services - Genetics
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation is a consultation service rendered by a Genetics specialist which is less demanding and 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, including a written request from a referring practitioner and a written report of findings and recommendations sent back to the referring practitioner. This service is provided to non-emergency patients in long-term care institutions, which include Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, and designated chronic or convalescent care beds in hospitals, excluding patients in designated palliative care beds. Refer to the General Preamble (, , ) for full consultation requirements.
When to Use
- Use W325 for a focused genetic review of a patient in a nursing home or chronic care facility where the clinical question is limited in scope compared to a comprehensive genetic workup.
- Select this code when providing a requested consultation for a stable, non-emergency patient in a designated chronic care bed, provided you have not previously billed K016 or K222 for the same patient.
Common Pitfalls
- Billing W325 after having already claimed K016 or K222 for the same patient will result in a payment of nil.
- Failing to obtain a formal written request from the referring practitioner or neglecting to send a formal written report back to them will cause the claim to be downgraded to a lower-value assessment fee upon audit.
- Using W325 for patients in designated palliative care beds is prohibited, as these are specifically excluded from the definition of eligible long-term care institutions for this code.
Billing Tips
- Ensure the referring practitioner's name and billing number are clearly documented in your clinical notes to satisfy the mandatory consultation requirements.
- If the patient is under 16 years of age, remember to append the appropriate age premium to maximize the claim value, as these are eligible for W325.
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.
The request must identify the consultant by name, the referring physician/nurse practitioner/dental surgeon by name and billing number, and the patient by name and health number.
The written request must set out information relevant to the referral and specify the service(s) required.
The consultant must prepare a written report including findings, opinions, and recommendations to the referring practitioner.
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