W407 – Admission assessment - Type 3
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Type 3 admission assessment is a general re-assessment of a patient who is re-admitted to the long-term care institution after a minimum 3 day stay in another institution. As per , a general re-assessment includes all the services listed for a general assessment, with the exception of the patient's history, which need not include all the details already obtained in the original assessment. This service applies to patients in non-emergency settings such as 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.
When to Use
- Use W407 when a patient returns to a long-term care facility following an acute care hospital admission lasting at least 72 hours.
- Use this code for a comprehensive re-assessment of a patient's clinical status upon their return from a convalescent or chronic care hospital stay of 3 days or more.
Common Pitfalls
- Billing W407 for patients returning from an acute hospital stay of less than 3 days, which will trigger a rejection for failing the minimum duration requirement.
- Attempting to bill W407 in conjunction with a Special Visit Premium; W-prefix codes are strictly for non-emergency institutional care and are incompatible with A-prefix emergency visit structures.
- Confusing W407 with W404; ensure the patient meets the specific 3-day absence threshold rather than using it for routine periodic reassessments.
Billing Tips
- Ensure the medical record explicitly notes the duration of the external hospital stay, as this is the primary audit trigger for validating the 3-day requirement.
- If the patient requires a full history and physical upon return, W407 is the appropriate code to capture the work involved in reintegrating the patient into the long-term care setting.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
The medical record must support the service as a general re-assessment, which requires a full, relevant history and physical examination of one or more systems (see ).
The record must document that the patient was re-admitted after a minimum 3-day stay in another institution.
This code is listed under NON-EMERGENCY LONG-TERM CARE IN-PATIENT SERVICES.
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