W463 – Infectious Disease Consultation - Nursing Home/Home for the Aged - First 2 Subsequent Visits
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit is a routine assessment following a patient's admission to a long-term care institution. W463 is specifically for the first two subsequent visits per patient per month in a nursing home or home for the aged, rendered by an Infectious Disease specialist. As per , a subsequent visit is any routine assessment following admission. This service includes the specific elements of an assessment as defined in , which involves a direct physical encounter with the patient, taking a history, performing an examination, and providing advice. See for general rules on subsequent visits in long-term care institutions.
When to Use
- Use W463 for the first two routine follow-up assessments of an infectious disease patient in a long-term care facility during a calendar month.
- Use this code when managing active infectious conditions that require specialist oversight but do not qualify for the comprehensive W010 monthly management fee.
Common Pitfalls
- Claiming W463 when the patient's primary physician has already billed W010 for the same calendar month, as W010 encompasses all subsequent visits.
- Billing W463 within six months of a Periodic Health Visit, which violates the specific timing restrictions mandated by the Nursing Homes Act.
- Submitting W463 for more than two visits per month, as the fee code is strictly limited to the first two subsequent visits.
Billing Tips
- Verify with the facility's billing office that no other physician has claimed W010 for the patient in the current month before submitting W463 to avoid automatic rejection.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
As an assessment, a direct physical encounter with the patient including taking a patient history and performing a physical examination is required, as outlined in .
May only be claimed 6 months after Periodic health visit (as per the Nursing Homes Act).
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