W345 – Consultation - Non-Emergency Long-Term Care In-Patient Services
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation by an Otolaryngologist for a patient in a long-term care institution, including Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, and designated chronic or convalescent care beds. This service is for non-emergency situations. As per the definition of a consultation in the Schedule of Benefits, this service is rendered following a written request from a referring physician, nurse practitioner, or dental surgeon. The consultant must be competent to give advice in the field due to the complexity, seriousness, or obscurity of the case, or because a second opinion is requested. The service includes all necessary steps to prepare a written report with findings, opinions, and recommendations for the referring practitioner.
When to Use
- Use W345 for a formal, non-emergency otolaryngology consultation requested by a primary provider for a patient residing in a long-term care facility or chronic care bed.
- Use this code when providing a second opinion or specialized assessment for a complex ENT condition that requires a written report back to the referring practitioner in an institutional setting.
Common Pitfalls
- Billing W345 for emergency assessments; W-prefix codes are ineligible for special visit premiums, so you must use the appropriate A-prefix code if the situation is an emergency.
- Failing to maintain a formal written referral request in the patient record, which is a mandatory requirement for all consultation codes under the Schedule of Benefits.
- Billing W345 for follow-up care or ongoing management; once the consultation is complete, subsequent visits must be billed as follow-up assessments, not as additional consultations.
Billing Tips
- Ensure your written report to the referring provider is comprehensive and clearly outlines your findings and recommendations, as this is the primary documentation required to justify the consultation fee.
- Verify the facility type qualifies as a long-term care institution under the Schedule of Benefits to avoid rejection, as this code is specifically restricted to these settings.
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, except in the case where common medical records are maintained.
The written request must identify the consultant by name, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies 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.
Non-Emergency Long-Term Care In-Patient Services includes Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, designated chronic or convalescent care beds in hospitals and nursing homes or homes for the aged, other than patients in designated palliative care beds.
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
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