W682 – Extended special neurology consultation
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
W682 is an extended special neurology consultation rendered to a non-emergency patient in a Long-Term Care Institution, which includes Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, and designated chronic or convalescent care beds. This service is subject to the same conditions as A682. As per A682, the physician must provide all elements of a consultation (A185) and spend a minimum of 90 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention. The service is only eligible for payment if start and stop times are recorded in the patient's permanent medical record. The calculation of time excludes time devoted to any other separately billable service/procedure and non-patient-facing time (e.g., reviewing charts, imaging, documentation). As a consultation, it must be initiated by a written request from a referring physician, nurse practitioner, or dental surgeon due to the complexity, seriousness, or obscurity of the case. The service includes all constituent elements of a consultation, such as a review of relevant data, an appropriate history and examination, and the preparation of a written report with findings, opinions, and recommendations for the referring practitioner. (Source: , , , , ).
When to Use
- Use W682 for a complex neurology consultation in a Long-Term Care (LTC) facility when the clinical assessment requires a minimum of 90 minutes of direct, face-to-face patient contact.
- Choose W682 over a standard W680 when the case complexity necessitates an extended duration that exceeds the scope of a routine consultation.
Common Pitfalls
- Including non-patient-facing time, such as chart review, imaging analysis, or report writing, in the 90-minute calculation will lead to audit recovery; only direct face-to-face time counts.
- Billing W682 for emergency assessments in an LTC setting is incorrect; W-prefix codes are strictly for non-emergency services, and emergency visits must be billed using A-prefix codes with appropriate premiums.
- Failing to document exact start and stop times in the medical record is a frequent cause for claim rejection or clawback during an audit.
Billing Tips
- Ensure the written referral request is clearly present in the patient's record, as the absence of this document will result in the claim being downgraded to a lower assessment fee.
- When calculating the 90-minute threshold, explicitly subtract any time spent on separately billable procedures performed during the same visit to ensure the remaining time meets the W682 requirement.
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 facility where common medical records are maintained, the written request may be contained on the common medical 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 to the referring practitioner.
Subject to the same conditions as A682.
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