W567 – 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 the long-term care institution after a minimum 3 day stay in another institution (as per ). This service is listed under the Paediatrics specialty. A general re-assessment includes all the services listed for a general assessment, with the exception of the patient's history, which need not include all the details already obtained in the original assessment (as per ). 'W' prefix services apply to patients in chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent care beds in hospitals.
When to Use
- Use W567 when a pediatric patient returns to a long-term care facility following an acute care hospital stay of at least 3 days.
- Use this code for a comprehensive re-assessment when the patient's clinical status has changed significantly during their absence, necessitating a formal re-evaluation.
Common Pitfalls
- Billing W567 in the same calendar month as W010 will trigger an automatic rejection, as the admission assessment is considered bundled into the monthly management fee.
- Claiming W567 for a patient who was away for fewer than 3 days is an audit risk; the 3-day threshold is a strict requirement under GP49.
- Using W567 for patients over 17 years of age is inappropriate, as this code is specifically designated under the Paediatrics specialty section.
Billing Tips
- Ensure the patient's chart clearly documents the duration of the external hospital stay to support the 3-day minimum requirement in the event of a post-payment audit.
- If the patient is re-admitted and you are not claiming the monthly management fee (W010) for that month, ensure you are not billing other 'A' prefix assessment codes that would be redundant to this 'W' prefix service.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
Service is listed under the Paediatrics specialty section.
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