W405 – Limited consultation
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation is an assessment that meets all the requirements of a full consultation but is less demanding and, in terms of time, normally requires substantially less of the physician's time (see ). As a consultation, it must be initiated by a written request from a referring physician, nurse practitioner, or dental surgeon for an expert opinion. The service includes a review of relevant data, an appropriate history and examination, and a written report of findings and recommendations to the referring practitioner (see ). The W prefix indicates this service is for non-emergency in-patients in a long-term care facility, such as a chronic care hospital, convalescent hospital, nursing home, or home for the aged.
When to Use
- Use W405 for a focused, non-emergency assessment of a long-term care patient when the clinical question is specific and does not require the comprehensive depth of a W400 consultation.
- Use this code when you are providing a second opinion or specialized management advice for a chronic care patient, provided you have a formal written request from the referring practitioner.
Common Pitfalls
- Billing W405 without a formal written request from the referring practitioner on file will lead to a clawback; a verbal request or a note in the chart stating 'referred by Dr. X' is insufficient.
- Attempting to bill W405 on the same day as a psychotherapy or counselling code (e.g., K007) by the same physician will trigger a rejection unless you can justify two distinct diagnoses.
- Using W405 for patients in acute care beds or palliative care beds is incorrect; ensure the patient is in a designated chronic care, convalescent, or nursing home setting to avoid audit issues.
Billing Tips
- If the complexity of the patient's condition exceeds the 'limited' scope, bill W400 instead of W405 to ensure appropriate compensation for the time and cognitive effort expended.
- Always ensure the referring physician's billing number is included in your documentation, as the Ministry requires this to validate the referral link for the W-prefix consultation.
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 practitioner, must be kept in the consulting physician's medical record. In a long-term care institution with a common medical record, the written request may be on the common 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 relevant information and specify the service(s) required.
The consultant must prepare a written report including findings, opinions, and recommendations to the referring practitioner.
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, other than patients in designated palliative care beds.
For emergency calls and other special visits to in-patients, use General Listings (A prefix) and Special Visit Premiums.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.