W404 – Admission assessment - Type 2
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Type 2 admission assessment is a non-emergency service that occurs when the admitting physician makes an initial visit to assess the condition of the patient following admission and has previously rendered a consultation, general assessment or general re-assessment of the patient prior to admission. This service applies to patients in 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.
When to Use
- Use W404 when you are the physician who previously performed a consultation or assessment on the patient and are now conducting the initial post-admission assessment for a chronic or convalescent care bed.
- Select W404 for non-emergency admissions to a Nursing Home or Home for the Aged where you have an established clinical history with the patient from a prior assessment.
Common Pitfalls
- Claiming W404 in the same month as W010 is a common rejection, as the Ministry considers the admission assessment included in the monthly management fee.
- Billing W404 for patients in designated palliative care beds is incorrect; these patients fall under different billing frameworks and will trigger audit flags.
- Attempting to bill W404 when you have not previously rendered a consultation or assessment for the patient; this code specifically requires a prior service relationship.
Billing Tips
- Ensure your billing software or manual claim reflects that this is a Type 2 assessment to distinguish it from a Type 1 (W402) admission assessment, which is reserved for patients where no prior assessment exists.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
As with all insured services, the service must be documented in the patient's medical record.
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.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.