W562 – Admission assessment - Type 1
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
W562 is a Type 1 admission assessment for a paediatric patient admitted to a non-emergency long-term care in-patient service. This service is defined as a general assessment rendered to a patient on admission (). A general assessment requires a full history (the elements of which must include a history of the presenting complaint, family medical history, past medical history, social history, and a functional inquiry into all body parts and systems), and, except for breast, genital or rectal examination where not medically indicated or refused, an examination of all body parts and systems, and may include a detailed examination of one or more parts or systems (). Applicable settings include chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent care beds in hospitals, excluding designated palliative care beds ().
When to Use
- Use W562 when performing the initial comprehensive admission assessment for a paediatric patient entering a chronic care or convalescent hospital bed.
- Use this code for the first formal assessment upon admission to a nursing home or home for the aged, provided the patient is under 18 years of age.
- Choose W562 instead of a standard A007 or A005 visit code when the service meets the full 'general assessment' criteria defined in GP21.
Common Pitfalls
- Billing W562 for patients in designated palliative care beds will result in rejection, as these are explicitly excluded from the GP49 definition.
- Submitting W562 after having already billed a consultation or general assessment for the same admission will trigger a payment adjustment to a lower fee.
- Failing to document a full systemic review and physical exam—as required by the GP21 definition of a 'general assessment'—will lead to clawbacks during an audit.
Billing Tips
- Ensure the patient's admission status is clearly recorded as chronic or convalescent care to justify the use of W562 over standard hospital visit codes.
- If the patient is under one year of age and requires surgical intervention, remember that W562 can be claimed in addition to the surgical fee for necessary medical supervision.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
All insured services must be documented in appropriate records establishing that an insured service was provided, the service claimed is the service rendered, and the service was medically necessary ().
Paediatric patient (newborn, infant, child, or adolescent as defined in GP2)
In surgical cases requiring medical direction, standard in-hospital medical fees are to be claimed in addition to the surgical fee. This includes all operations on babies under one year of age, and all other older children who require medical supervision.
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