W395 – Limited consultation
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation is a consultation service rendered by a psychiatrist in a non-emergency long-term care setting. According to , it is a consultation that is less demanding and normally requires substantially less of the physician's time than a full consultation. However, it must otherwise meet all the requirements of a full consultation as outlined in , including a written request from a referring practitioner and a written report of findings and recommendations sent back to the referring practitioner. The 'W' prefix designates this service for patients in settings such as Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, and Homes for the Aged, as specified on page of the Schedule.
When to Use
- Use W395 for a psychiatric consultation in a long-term care setting when the clinical complexity does not warrant the time or depth required for a full consultation (W895).
- Use this code for routine psychiatric evaluations of long-term care residents where a formal written referral is present but the clinical scope is focused and limited in duration.
Common Pitfalls
- Billing W395 without a formal written referral from the attending physician or nurse practitioner, which leads to automatic downgrades to a lower assessment fee.
- Failing to provide a formal written report back to the referring practitioner, as W395 requires the same documentation standards as a full consultation (GP16).
- Using W395 for emergency psychiatric assessments in long-term care, which should instead be billed using the appropriate emergency visit codes and premiums.
Billing Tips
- Ensure the referring practitioner's name and billing number are clearly documented in your chart to satisfy the requirements of GP16.
- If you perform multiple consultations for the same patient, ensure you are not exceeding frequency limits, as claims exceeding these will be automatically adjusted to a general assessment fee.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
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 settings with a common medical record (e.g., long-term care institution), the written request may be contained on the common medical record.
The request must identify the consultant by name, the referring practitioner by name and billing number, and 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 provided to the referring practitioner.
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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