W409 – Periodic health visit
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A periodic health visit is performed on a patient, after their second birthday, who presents and reveals no apparent acute physical or mental illness. The service must include an intermediate assessment, a level 2 paediatric assessment or a partial assessment focusing on age and gender appropriate history, physical examination, health screening and relevant counselling. This service is specifically for patients in Non-Emergency Long-Term Care settings such as Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, and designated chronic or convalescent care beds in hospitals.
When to Use
- Use W409 for the annual health review of a patient residing in a Nursing Home or Home for the Aged who is stable and lacks acute illness.
- Use this code for routine physical assessments in chronic care or convalescent hospital beds when the patient does not require an acute care intervention.
- Choose W409 over W055 or W050 when the primary purpose of the encounter is a scheduled periodic health review rather than an assessment of a new or changing clinical problem.
Common Pitfalls
- Billing W409 more than once per 12-month period per physician will result in automatic rejection by OHIP.
- Attempting to bill W409 in conjunction with special visit premiums (e.g., travel or after-hours) is prohibited; use General Listing assessment codes (e.g., A005) with premiums instead.
- Using W409 for patients in palliative care beds is incorrect, as these patients are explicitly excluded from the scope of this code.
Billing Tips
- Ensure the patient is over two years of age, as W409 is strictly restricted to patients who have passed their second birthday.
- If the patient presents with an acute issue during the visit, bill a standard assessment code (e.g., W055) instead of W409 to reflect the complexity of the acute care provided.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
As an assessment, this service must include a direct physical encounter with the patient including taking a patient history and performing a physical examination, as per the specific elements of assessments on .
The medical record must establish that an insured service was provided, the service claimed is the service that was rendered, and the service was medically necessary.
Patient must be after their second birthday.
Applies to Non-Emergency Long-Term Care In-Patient Services, which 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 to .
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