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W425
W425 – Comprehensive physical medicine and rehabilitation consultation
OHIP Consultations and Visits Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A comprehensive physical medicine and rehabilitation consultation rendered for a patient in a non-emergency long-term care setting (e.g., chronic care hospital, nursing home). This service must be initiated by a written request from a referring physician, nurse practitioner, or dental surgeon due to the complexity, seriousness, or obscurity of the case, or at the patient's request for a second opinion.
The service includes all constituent elements of a consultation as defined in the Schedule of Benefits (, ), including:
• A direct physical encounter with the patient.
• A full history of the presenting complaint and detailed examination of the affected part(s), region(s), or system(s).
• Review of all relevant data.
• Preparation of a written report with findings, opinions, and recommendations sent to the referring practitioner.
This service is subject to the same conditions as A425. A comprehensive physical medicine and rehabilitation consultation requires the physician to spend a minimum of 75 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention. The start and stop time must be recorded in the patient’s permanent medical record or the payment for the service will be reduced to a lesser fee.
Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon
A copy of the written request for the consultation, signed by the referring physician, nurse practitioner, or dental surgeon must be kept in the consulting physician's medical record. In facilities with a common medical record, the written request may be contained on that record.
The written request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number.
The consulting physician must prepare a written report including findings, opinions, and recommendations to the referring practitioner.
The start and stop time must be recorded in the patient’s permanent medical record or the payment for the service will be reduced to a lesser fee.
subject to the same conditions as A425
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