W400 – Comprehensive community medicine consultation
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A comprehensive community medicine consultation rendered to a non-emergency in-patient in a Long-Term Care (LTC) Institution, such as a chronic care hospital, convalescent hospital, nursing home, or home for the aged. This service is subject to the same conditions as A400. As a consultation, it must be initiated by a written request from a referring physician, nurse practitioner, or dental surgeon, as detailed in . The service includes a comprehensive history and examination appropriate for the patient's complex, serious, or obscure condition, and culminates in a written report with findings, opinions, and recommendations sent to the referring practitioner.
When to Use
- Use W400 for a formal, comprehensive assessment of a complex or obscure condition in a patient residing in a long-term care facility, initiated by a written referral from a physician, nurse practitioner, or dental surgeon.
- Use W400 when the patient has not been seen by you for the same diagnosis within the previous 24 months, or for a clearly defined unrelated diagnosis within the previous 12 months.
Common Pitfalls
- Claiming W400 without a documented written referral request on file, which will result in a clawback to a lower assessment fee during an audit.
- Billing W400 for routine follow-up visits or ongoing management of a previously consulted condition, which should be billed as a subsequent visit code.
- Failing to send a formal written report to the referring practitioner, as the consultation is not considered complete for billing purposes without this documentation.
Billing Tips
- Ensure the written referral is clearly documented in the patient's chart, including the referring provider's name and billing number, to satisfy the requirements of GP16.
- Always pair W400 with the appropriate W-series travel premium (W960-W964) if you are traveling to the LTC facility specifically for this consultation, as these are distinct from the consultation fee itself.
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.
subject to the same conditions as A400
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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