W444 – General re-assessment of patient in nursing home
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A general re-assessment conducted for a patient in a nursing home. As per the definition of general re-assessment on page , this service includes all the components of a general assessment, but the patient's history may not require all the details of the original assessment. This service is intended for non-emergency, in-patient care in a long-term care setting as described on page . A critical payment condition, noted on page , is that this service may only be claimed 6 months after a periodic health visit (W849) has been performed as per the Nursing Homes Act.
When to Use
- Use W444 for a comprehensive, non-emergency re-assessment of a long-term care patient when the clinical complexity exceeds a standard visit but does not qualify as a full periodic health visit.
- Use this code when conducting a scheduled, periodic review of a patient's chronic conditions and medication management in a nursing home setting, provided it occurs at least 6 months after the W849.
Common Pitfalls
- Billing W444 on the same day or within the same month as W010 will result in an automatic rejection, as the nursing home management fee is inclusive of routine assessments.
- Exceeding the limit of two W444 claims per 12-month period will trigger an automatic payment adjustment to a lower-valued assessment fee.
- Claiming W444 within 6 months of a W849 is a common audit trigger and will result in a recovery of funds because the periodic health visit is the primary requirement under the Nursing Homes Act.
Billing Tips
- Ensure your billing software tracks the date of the last W849 to avoid claiming W444 prematurely, as the 6-month interval is a strict regulatory requirement.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
May only be claimed 6 months after Periodic health visit (as per the Nursing Homes Act).
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