W385 – Limited consultation
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation provided by a specialist in Neurology (18). This service applies to patients in 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. As per the preamble, a limited consultation is an assessment 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. As per , a full consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon who requests the opinion of a consultant physician because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient. The consultant must prepare a written report for the referring practitioner.
When to Use
- Use W385 when performing a requested neurological consultation for a patient residing in a long-term care facility or nursing home, provided the assessment is less extensive than a full consultation (A185).
- Use this code for a neurological opinion on a patient in a chronic care bed when the referral request is documented in the common medical record, ensuring the service does not meet the complexity threshold of a full consultation.
Common Pitfalls
- Billing W385 for patients in designated palliative care beds is prohibited; these services must be billed using appropriate assessment codes.
- Attempting to claim a special visit premium with W385 will result in rejection, as special visit premiums require an 'A' prefix assessment code.
- Failure to document a formal written request from the referring practitioner will lead to the claim being downgraded to a lower-value assessment fee.
Billing Tips
- Ensure the written referral is clearly identifiable in the patient's chart, as the Ministry frequently audits the existence of the referral request for W385 claims.
- If the neurological assessment is complex and time-intensive, bill A185 instead of W385 to avoid under-billing and to accurately reflect the scope of the consultation.
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.
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