W517 – Admission assessment - Type 3
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Type 3 admission assessment is a general re-assessment of a patient who is re-admitted to a long-term care institution after a minimum 3 day stay in another institution. This service applies to non-emergency in-patients in Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, and designated chronic or convalescent care beds in hospitals, but not to patients in designated palliative care beds. As a general re-assessment, it includes all the services of a general assessment, with the exception of the patient's history, which does not need to include all details already obtained in the original assessment.
When to Use
- Use W517 when a patient returns to a long-term care facility following a minimum 3-day acute care hospital admission for a non-emergency condition.
- Use this code for a comprehensive re-assessment of a chronic care patient who has been transferred back from a convalescent hospital stay exceeding 72 hours.
Common Pitfalls
- Billing W517 for patients returning from palliative care beds, which are explicitly excluded from this code's eligibility criteria.
- Submitting W517 when the patient's absence from the facility was less than the mandatory 3-day (72-hour) threshold, which will trigger an automatic rejection.
- Confusing W517 with A004 or C004; W517 is specific to institutional re-admissions and does not carry the same requirements as a standard office or hospital general assessment.
Billing Tips
- Ensure the medical record clearly notes the date of discharge from the other institution and the date of re-admission to verify the 3-day minimum stay requirement for audit purposes.
- If the re-admission assessment occurs during an emergency or requires an urgent visit, bill the appropriate 'A' prefix code with a Special Visit Premium instead of W517.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
As a general re-assessment, the service must include all the elements 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. The service must be documented in the patient's medical record.
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