W464 – Subsequent visit - Infectious Disease
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A general re-assessment of a patient in a nursing home, as required by the Nursing Homes Act. A general re-assessment includes all the services of a general assessment, with the exception of the patient's history, which need not include all the details already obtained in the original assessment (). This service applies to patients in non-emergency, long-term care in-patient settings, including chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent care beds in hospitals, but excludes patients in designated palliative care beds (, ).
When to Use
- Use W464 when performing the mandatory periodic general re-assessment for a nursing home patient as required by the Nursing Homes Act.
- Use this code when the clinical service provided is a comprehensive re-assessment that exceeds the scope of a standard follow-up visit but is not a monthly management service.
Common Pitfalls
- Do not claim W464 in the same calendar month as W010, as the monthly management fee already includes the general re-assessment component.
- Avoid claiming W464 more than twice in a 12-month period, as subsequent claims will be automatically adjusted to a lower assessment fee.
- Do not attempt to add the 15% age-based premium to W464, as it is not eligible for this adjustment under the current Schedule of Benefits.
Billing Tips
- If you are called to the facility for an urgent or emergency assessment, bill an 'A' prefix code instead of W464 to ensure eligibility for applicable special visit premiums.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
Must be performed as per the Nursing Homes Act.
May only be claimed 6 months after Periodic health visit (as per the Nursing Homes Act).
* May only be claimed 6 months after Periodic health visit (as per the Nursing Homes Act).
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