W355 – Urology consultation - Non-Emergency Long-Term Care In-Patient Services
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A urology (<specialtyCode>35</specialtyCode>) consultation for a non-emergency patient in a Long-Term Care Institution, which includes chronic care hospitals, convalescent hospitals, nursing homes, and homes for the aged. This service is not for patients in designated palliative care beds. It requires a written request from a referring physician, nurse practitioner, or dental surgeon, and the consultant must provide a written report back. The service includes the necessary history and examination to provide a medical opinion. It may also include physical examination of the genito-urinary tract and procedures such as urethral calibration, catheterization, and prostatic fluid examination. Endoscopic examinations are explicitly excluded and should be billed separately. For emergency calls or special visits, an A-prefix code from the General Listings must be used instead of W355, along with the appropriate Special Visit Premiums.
When to Use
- Use W355 for a scheduled, non-urgent urological consultation for a patient residing in a nursing home or home for the aged.
- Use this code when providing a formal medical opinion on a chronic urological issue (e.g., recurrent catheter complications) where a written referral from the primary provider is present.
Common Pitfalls
- Billing W355 for emergency visits; these must be billed using an 'A' prefix code (e.g., A355) with the appropriate Special Visit Premium.
- Failing to document the written referral or the subsequent written report, which triggers an automatic adjustment to a lower assessment fee during audit.
- Billing W355 for endoscopic procedures; these are explicitly excluded and must be claimed as separate procedural codes.
Billing Tips
- Ensure the referring physician's billing number is clearly documented in your records to satisfy the mandatory referral requirements for consultation codes.
- If you perform a procedure during the visit, ensure it is billed separately, as W355 only covers the consultation and basic physical exam maneuvers like catheterization.
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. In a long-term care institution where common medical records are maintained, the written request may be contained on the common medical record.
The written request must identify the consultant by name, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identify 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.
A written report (including findings, opinions, and recommendations) must be prepared and sent to the referring practitioner.
*May include physical examination pertaining to the genito-urinary tract and when necessary such procedures as urethral calibration, catheterization and prostatic fluid examination, but not to include endoscopic examination.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.