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W442
W442 – First 4 subsequent visits per patient per month - Chronic care or convalescent hospital
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit for a patient in a chronic care or convalescent hospital, rendered by a physician in Medical Oncology. This service is a routine assessment following the patient's admission to the institution. Payment is limited to the first four subsequent visits per patient per month. For details on services in Long-Term Care Institutions, see General Preamble page . For additional visits beyond the fourth in a month, see W441.
When to Use
- Use W442 for the first four routine follow-up assessments per month for a patient admitted to a chronic care or convalescent facility under your care as a Medical Oncologist.
- Use this code for ongoing monitoring of a patient's chronic condition when they do not meet the criteria for a comprehensive monthly management fee.
Common Pitfalls
- Billing W442 in the same month as W010 will trigger an automatic rejection, as the monthly management fee is intended to cover all routine subsequent visits.
- Attempting to attach a special visit premium to W442 will result in a rejection; use an 'A' prefix assessment code instead if an urgent, non-elective visit is required.
- Exceeding the four-visit limit per month will result in payment denials for the fifth visit and beyond; use W441 for any subsequent visits exceeding the monthly cap.
Billing Tips
- Track your visit count carefully throughout the month to ensure you switch to W441 once the four-visit threshold for W442 is reached.
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