W460 – Subsequent visit by a specialist in infectious disease
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Comprehensive infectious disease consultation - subject to the same conditions as A460
When to Use
- Use W460 for a comprehensive infectious disease consultation when the patient has been referred by another physician or nurse practitioner for a specific diagnostic or management opinion.
- Use this code when the patient has not been seen by you for the same diagnosis within the preceding 12 months, ensuring the consultation criteria are met.
Common Pitfalls
- Billing W460 when the patient is already under your active care for the same diagnosis, which should instead be billed as a subsequent visit (e.g., W465).
- Failing to retain a formal written referral request in the medical record, which leads to automatic downgrades to a lesser assessment fee during audits.
- Attempting to bill W460 for routine follow-up visits after the initial consultation has already established a management plan.
Billing Tips
- Ensure the referring practitioner's name and billing number are clearly documented in the patient chart to satisfy the mandatory referral requirements for W460.
- Apply the appropriate age-based premium code (e.g., AGE_PREMIUM_UNDER_16_YEARS) on the same claim to maximize the specialist fee for eligible pediatric patients.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
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 a long-term care institution where common medical records are maintained, the written request may be contained on the 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.
Subject to the same conditions as A460.
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