W419 – Periodic health visit
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A periodic health visit provided to an in-patient in a non-emergency long-term care setting (e.g., Chronic Care Hospital, Nursing Home). This service is defined in as an assessment for a patient, after their second birthday, who presents with no apparent acute physical or mental illness. It includes an intermediate assessment, or similar, focusing on age and gender-appropriate history, physical examination, health screening, and relevant counselling. As a 'W' prefix code, it is for non-emergency care. For emergency services, 'A' prefix codes with special visit premiums should be used. This service is considered a component of the W010 monthly management fee and is not payable separately in the same month.
When to Use
- Use W419 for an annual wellness check-up for a long-term care resident who is stable and asymptomatic.
- Use this code when performing a comprehensive age-appropriate health screening that goes beyond the scope of routine monthly monitoring.
Common Pitfalls
- Billing W419 in the same calendar month as W010 will result in an automatic rejection, as the periodic assessment is included in the monthly management fee.
- Claiming W419 more than once every 12 months per physician will trigger a rejection or audit, as it is strictly limited to one per year per provider.
Billing Tips
- Ensure the patient is at least two years of age at the time of service to avoid eligibility rejections.
- If the patient presents with an acute illness during the visit, bill an appropriate assessment code instead of W419 to accurately reflect the clinical encounter.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
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.
Performed on a patient after their second birthday.
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