W465 – Consultation
OHIP Neurology Code — Infectious Disease (46) · Schedule of Benefits
This service is a consultation rendered by a specialist in Infectious Disease (46) for a patient in a non-emergency long-term care setting, such as a Chronic Care Hospital, Convalescent Hospital, Nursing Home, or Home for the Aged. As a consultation, it requires a written request from a referring physician, nurse practitioner, or dental surgeon as described in the General Preamble (). The service includes a comprehensive assessment and a written report to the referring practitioner. For emergency or special visits, an 'A' prefix code must be used instead of W465.
When to Use
- Use W465 for the initial infectious disease evaluation of a patient residing in a nursing home or home for the aged when requested by the primary care provider.
- Use W465 for consultations in chronic care or convalescent hospital settings where the patient does not meet the criteria for emergency or palliative care billing.
Common Pitfalls
- Billing W465 for an emergency infectious disease consult, which should instead be billed using A465 plus the appropriate special visit premiums.
- Exceeding the frequency limit of one consultation per 24 months for the same diagnosis, which triggers an automatic reduction to a lower assessment fee.
- Failing to ensure the referring practitioner's name and billing number are clearly documented in the consultation report, which is a common audit trigger for GP16 compliance.
Billing Tips
- Always verify that the referral request explicitly states the reason for the infectious disease consult, as vague requests may lead to claim rejection or payment reduction.
- If providing follow-up care for the same condition within the 24-month window, bill the appropriate follow-up assessment code (e.g., W466) rather than attempting to re-bill W465.
Effective: June 1, 2025
Consultations and Visits
Infectious Disease (46)
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, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
The request identifies the consultant by name, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
A written report (including findings, opinions, and recommendations) must be provided to the referring physician, nurse practitioner or dental surgeon.
Patient 17 years of age or older.
Non-Emergency Long-Term Care In-Patient Services 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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