W461 – Additional subsequent visits - chronic care or convalescent hospital
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service represents an additional subsequent visit to a patient in a chronic care or convalescent hospital, rendered by a specialist in Infectious Disease (46). It is applicable for the fifth and sixth visits within a single month, following the initial four visits which are claimed using W462. A subsequent visit is a routine assessment following the patient's admission to a long-term care institution, as defined in . The total number of routine subsequent visits per patient, per month (a combination of W462 and W461) is limited to a maximum of six.
When to Use
- Use W461 for the fifth and sixth subsequent visits in a calendar month for an Infectious Disease specialist after the four W462 claims are exhausted.
- Apply this code specifically for routine follow-up assessments of patients admitted to chronic care or convalescent hospital facilities.
Common Pitfalls
- Claiming W461 before the four allowed W462 visits are billed will result in automatic rejection or adjustment to zero.
- Exceeding the monthly cap of six total visits (W462 plus W461) will trigger a payment adjustment to zero for the excess claims.
- Billing W461 for patients in acute care hospitals is incorrect; this code is strictly reserved for chronic care or convalescent institutional settings.
Billing Tips
- Track your monthly visit count per patient carefully to ensure you do not exceed the six-visit limit, as the Ministry will not pay for services beyond this threshold.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
As per , all assessments require a direct physical encounter with the patient, including a patient history and physical examination, with appropriate documentation in the medical record.
May only be claimed 6 months after Periodic health visit (as per the Nursing Homes Act).
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