All codes
W468
W468 – Subsequent visits per month (maximum of 3 per patient per month) - Nursing home or home for the aged
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Subsequent visit for a patient in a nursing home or home for the aged rendered by a specialist in Infectious Disease (46). As defined in of the Schedule, a subsequent visit is any routine assessment following the patient's admission to a long-term care institution. This service includes the specific elements of assessments as outlined in .
When to Use
- Use W468 for routine follow-up assessments of an Infectious Disease patient in a nursing home when the patient is stable and does not require the monthly management oversight provided by W010.
- Use W468 when providing a scheduled follow-up for a chronic infection that does not qualify as an acute intercurrent illness requiring the W121 code.
Common Pitfalls
- Billing W468 in the same month as W010 will trigger an automatic rejection, as the Ministry considers routine visits included in the monthly management fee.
- Attempting to attach special visit premiums to W468 is a common audit trigger; this code is strictly for routine visits and does not support premium modifiers.
- Exceeding the maximum of 3 claims per patient per month will result in the rejection of the fourth and subsequent claims.
Billing Tips
- If you are called to the facility to assess a patient for an acute intercurrent illness, use W121 instead of W468 to ensure appropriate compensation for the acute nature of the visit.
- Ensure your documentation clearly distinguishes between routine follow-up (W468) and acute intercurrent illness (W121) to justify the code selection during a potential post-payment review.
Provider Fee$0.00
Specialist Fee$34.10
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Assessment
Code Classes
Hospital and Institutional Consultations and Assessments
May only be claimed 6 months after Periodic health visit (as per the Nursing Homes Act).
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