W443 – First 2 subsequent visits per patient per month - Nursing home or home for the aged
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service is for a routine, non-emergency subsequent assessment for a patient in a nursing home or home for the aged. It applies to the first two (2) subsequent visits per patient per calendar month. For emergency calls, special visits, or visits for acute intercurrent illness, other codes apply (see and to ). This service is considered a component of the monthly management fee (W010) and is not separately payable if W010 is claimed for the same month.
When to Use
- Use W443 for the first two routine, non-emergency follow-up assessments per patient per calendar month in a long-term care facility.
- Use this code for planned medication reviews or routine chronic disease monitoring when the patient is not experiencing an acute intercurrent illness.
Common Pitfalls
- Billing W443 in the same month as W010 will result in an automatic rejection, as the monthly management fee is intended to cover these routine visits.
- Attempting to attach a Special Visit Premium (e.g., K963) to W443 is a common error; W443 is strictly for routine visits and does not support emergency or after-hours premiums.
- Claiming W443 for a third or subsequent visit in the same month will be rejected; use W448 for any visits beyond the first two.
Billing Tips
- Track your monthly visit count per patient carefully to ensure you switch to W448 after the second visit to avoid unnecessary rejections.
- If you are managing the patient under the W010 monthly management fee, do not bill W443 at all, as the service is already compensated within the management fee structure.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
As per standard medical record requirements outlined in and , an appropriate record of the assessment must be maintained.
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