W514 – Admission assessment - Type 2
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Type 2 admission assessment occurs when the admitting physician makes an initial visit to assess the condition of the patient following admission and has previously rendered a consultation, general assessment or general re-assessment of the patient prior to admission. This service is for patients in chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent care beds in hospitals. As an assessment, it includes the specific elements of a direct physical encounter with the patient (history and physical examination), making arrangements for related care, and providing advice to the patient or their representative, as described in of the Schedule.
When to Use
- Use W514 when you admit a patient to a long-term care facility or chronic care bed after having performed a formal consultation or general assessment on that same patient within a reasonable timeframe prior to admission.
- Use this code for the initial post-admission assessment in a nursing home or chronic care setting when the patient's clinical history is already established in your records via a prior A510 or A511.
Common Pitfalls
- Claiming W514 in the same month as W010 will trigger an automatic rejection, as W514 is considered a component of the monthly management fee.
- Billing W514 when no prior consultation or general assessment exists in the patient's history is a common audit trigger for improper code selection.
- Attempting to bill W514 for patients in designated palliative care beds is incorrect, as these beds are explicitly excluded from the scope of this code.
Billing Tips
- Ensure your billing software or manual submission confirms the absence of a W010 claim for the current calendar month to avoid payment recovery.
- Verify that the prior service (A510, A511, or consultation) is clearly documented in the patient's chart to satisfy the 'previously rendered' requirement during a Ministry audit.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
This service applies to patients in 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.
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