W375 – Limited consultation
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation rendered by a Geriatrics (07) specialist, which is less demanding and, in terms of time, normally requires substantially less of the physician's time than the full consultation. This service is for non-emergency in-patients in a long-term care institution, including Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, and Homes for the Aged. All requirements for a consultation, as defined in the Schedule on page , must be met, including a written request from a referring practitioner and a subsequent written report to that practitioner.
When to Use
- Use W375 for a focused geriatric assessment in a long-term care facility where the clinical complexity does not warrant the full scope of a W075 consultation.
- Select this code when providing a secondary opinion on a specific, non-complex geriatric issue (e.g., medication review or mobility assessment) for an existing long-term care resident.
Common Pitfalls
- Billing W375 without a formal written request from the referring practitioner, which is a mandatory requirement for all consultation codes under GP16.
- Failing to provide a formal written report back to the referring practitioner, which is a prerequisite for the consultation fee to be valid.
- Attempting to claim special visit premiums with W375, which is generally restricted; ensure you are not confusing W-prefix institutional codes with A-prefix emergency codes.
Billing Tips
- Ensure the referring physician's name and billing number are clearly documented in the patient's chart to satisfy the audit requirements for a valid referral.
- If the patient's condition requires a more comprehensive evaluation than a limited consultation allows, bill W075 instead to reflect the higher complexity and time commitment.
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 of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
The request identifies the consultant by name and/or the specialty being consulted, 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 sets out the information relevant to the referral and specifies the service(s) required.
A consultation includes the services necessary to enable the consultant to prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon. Where the referral is made by a nurse practitioner, the consultant shall provide the report to the nurse practitioner and the patient’s primary care provider, if applicable.
A limited consultation is a consultation which is less demanding and, in terms of time, normally requires substantially less of the physician's time than the full consultation. Otherwise, a limited consultation has the same requirements as a full consultation.
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