W565 – Limited consultation
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation is a consultation which is less demanding and, in terms of time, normally requires substantially less of the physician's time than the full consultation. Otherwise, a limited consultation has the same requirements as a full consultation. Consultation Requirements (as per ): A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon. The consultant is required to perform an assessment, review relevant data, and prepare a written report (including findings, opinions, and recommendations) for the referring practitioner. The written request must be kept in the patient's medical record. 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, excluding patients in designated palliative care beds.
When to Use
- Use W565 for a focused specialist assessment of a patient in a nursing home or chronic care facility when the clinical complexity does not warrant the time intensity of a full consultation (W265).
- Select W565 when providing a requested opinion on a stable long-term care patient where the review of records and physical examination is limited in scope compared to a comprehensive initial consultation.
Common Pitfalls
- Billing W565 for patients in palliative care beds is a common audit trigger, as these are explicitly excluded from the W565 definition.
- Failing to maintain the written referral request in the patient’s record will result in a clawback, as W565 strictly requires the same documentation rigor as a full consultation.
- Using W565 for patients in acute care beds; this code is restricted to chronic, convalescent, nursing home, or homes for the aged settings.
Billing Tips
- Ensure your written report to the referring practitioner explicitly highlights the findings and recommendations to satisfy the consultation requirement, even if the assessment was 'limited' in time.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician's medical record. In a hospital, long-term care institution or multi-specialty clinic with common medical records, the written request may be on the common record.
The request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number.
The written request must set out the information relevant to the referral and specify the service(s) required.
The consultant must prepare a written report (including findings, opinions, and recommendations) for the referring practitioner.
NON-EMERGENCY LONG-TERM CARE IN-PATIENT SERVICES includes 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. For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
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