W564 – 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 applies to 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, this service includes the specific elements outlined on page (e.g., history, examination, advice) and the common elements of all insured services as per pages -.
When to Use
- Use W564 when admitting a patient to a chronic or convalescent bed if you have already billed a consultation (W262) or general assessment (W261) for that patient within the preceding 12 months.
- Apply this code for the initial post-admission assessment in a nursing home or home for the aged when a prior assessment or consultation has been documented in the patient's record.
Common Pitfalls
- Billing W564 as an initial admission assessment when no prior consultation or assessment exists; in such cases, W562 is the correct code.
- Attempting to bill W564 in an acute care hospital setting, as this code is strictly restricted to chronic care, convalescent, or long-term care facilities.
- Submitting W564 for daily follow-up visits, which should instead be billed using the appropriate W-prefix subsequent visit codes.
Billing Tips
- Ensure your clinical notes explicitly reference the previous consultation or assessment date to justify the use of the Type 2 assessment code over the Type 1 (W562) code.
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