W512 – Admission assessment - Type 1
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Type 1 admission assessment is a general assessment rendered to a patient on admission to a long-term care institution. This service applies to patients in chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent care beds in hospitals, excluding patients in designated palliative care beds. As defined on page , a general assessment requires: - A full history, including a history of the presenting complaint, family medical history, past medical history, social history, and a functional inquiry into all body parts and systems. - An examination of all body parts and systems (except for breast, genital or rectal examination where not medically indicated or refused), and may include a detailed examination of one or more parts or systems.
When to Use
- Use W512 when performing the initial comprehensive admission assessment for a patient newly admitted to a nursing home or home for the aged.
- Use W512 for the initial assessment of a patient transferred into a designated chronic care or convalescent bed, provided they are not in a palliative care bed.
Common Pitfalls
- Billing W512 when the patient is already covered under the monthly management fee W010, as the admission assessment is considered included in the management fee.
- Attempting to claim special visit premiums with W512, which is explicitly prohibited by the Schedule of Benefits.
- Failing to document a full systems review and history, which is a mandatory requirement for the 'General Assessment' definition under GP21.
Billing Tips
- Ensure you do not bill W512 if you have already performed a consultation or general assessment on the same patient shortly before the admission, as the fee will be automatically adjusted downward.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
All insured services must be documented in the patient's medical record to establish the service was provided, is the service claimed, and was medically necessary.
The service must include a direct physical encounter with the patient, including taking a patient history and performing a physical examination, as per the specific elements of assessments.
Requires a full history, including history of the presenting complaint, family medical history, past medical history, social history, and a functional inquiry into all body parts and systems.
Requires an examination of all body parts and systems, except where not medically indicated or refused for breast, genital, or rectal examinations.
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