W445 – Consultation - Non-Emergency Long-Term Care In-Patient Services
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
W445 is a consultation rendered by a Medical Oncology specialist for a patient in a long-term care institution. This service is provided following a written request from a referring practitioner (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 a comprehensive assessment, review of all relevant data, and preparation of a written report for the referring practitioner. Per and , 'W' prefix codes apply specifically to non-emergency services for in-patients of chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent care beds.
When to Use
- Use W445 when a Medical Oncologist performs a formal consultation for a patient residing in a long-term care facility, nursing home, or chronic care bed following a written request.
- Use this code for complex oncology assessments where a second opinion or specialized management plan is required for a patient already established in a chronic care or convalescent setting.
Common Pitfalls
- Billing W445 in the same calendar month as W010 is a common rejection, as the Ministry considers the consultation a component of the monthly management fee.
- Attempting to add special visit premiums to W445 will result in rejection; you must use 'A' prefix codes if the service meets the criteria for a special visit.
- Failure to maintain the written referral request in the patient's chart will result in a clawback to a lower assessment fee during an audit.
Billing Tips
- Ensure the written referral explicitly names the consulting Medical Oncologist to satisfy the documentation requirements for a valid consultation claim.
- If the patient requires an emergency assessment in a long-term care setting, bill an 'A' prefix code instead of W445 to allow for the application of appropriate special visit premiums.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
A copy of the written request for the consultation, signed by the referring practitioner, must be kept in the consulting physician's medical record (unless in a facility with a common medical record).
The request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number.
The written request must set out the information relevant to the referral and specify the service(s) required.
Patient is 17 years of age or older. For patients 16 and under, see W765.
Applies to Non-Emergency Long-Term Care In-Patient Services which includes Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, designated chronic or convalescent care beds in hospitals and nursing homes or homes for the aged, other than patients in designated palliative care beds.
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
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