W645 – Consultation - Non-Emergency Long-Term Care In-Patient Services
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation service rendered by a General Thoracic Surgery specialist following a written request from a referring practitioner for a patient in a Long-Term Care Institution (e.g., chronic care hospital, nursing home). The service requires a comprehensive assessment and a written report back to the referring practitioner. As per , a copy of the written request must be kept in the patient's record. This 'W' prefix code is for non-emergency, in-patient services and is not applicable to patients in designated palliative care beds. For emergency calls or other special visits, an 'A' prefix code with the appropriate Special Visit Premium must be used instead. Payment is subject to limitations based on frequency for the same diagnosis or an unrelated diagnosis as detailed in .
When to Use
- Use W645 when performing a non-emergency, comprehensive thoracic surgical assessment for a patient residing in a nursing home or chronic care facility following a formal written request.
- Use this code for initial consultations in long-term care settings where the patient is not in a designated palliative care bed, as palliative patients require different billing protocols.
Common Pitfalls
- Billing W645 without a formal written request from the referring practitioner on file, which will result in an automatic downgrade to a lower-value assessment code upon audit.
- Attempting to bill W645 for patients in palliative care beds, which is explicitly excluded; these services should be billed under the appropriate palliative care or general visit codes.
- Failing to include the referring practitioner's billing number on the written request, which is a mandatory documentation requirement under GP16.
Billing Tips
- Ensure the written request is dated prior to the service date; if you request the referral after the service is rendered, you must bill a standard visit code instead of W645.
- If you see the patient again for the same condition within the frequency limits defined in GP17, you cannot bill another W645 and must instead use a follow-up assessment code.
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 setting with a common medical record, the written request may be contained on the common medical record.
The written request must identify the consultant by name, the referring physician, nurse practitioner or dental surgeon by name and billing number, and the patient by name and health number.
The consultant must prepare a written report including findings, opinions, and recommendations to 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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