W695 – Neurodevelopmental consultation
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A neurodevelopmental consultation is a specific type of consultation provided to a non-emergency in-patient in a Long-Term Care Institution, which includes settings such as Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, and designated chronic or convalescent care beds in hospitals. This service is not applicable to patients in designated palliative care beds. As a consultation, it requires a written request from a referring physician, nurse practitioner, or dental surgeon for an expert opinion on a patient's condition. The service includes a comprehensive assessment, review of relevant data, and the preparation of a written report with findings, opinions, and recommendations for the referring practitioner. This service is subject to the same conditions as A695.
When to Use
- Use W695 when providing a formal, requested consultation for a complex neurodevelopmental condition specifically for a patient residing in a long-term care facility or chronic care hospital.
- Choose W695 over standard assessment codes when the clinical complexity requires a comprehensive neurodevelopmental evaluation and a formal written report back to the referring practitioner.
Common Pitfalls
- Billing W695 in the same month as W010 is prohibited, as the monthly management fee is intended to cover routine assessments and oversight.
- Failure to document start and stop times in the patient's record will lead to a rejection or a downgrade to a lower-value assessment fee during an audit.
- Attempting to bill W695 for patients in designated palliative care beds is a violation of the code's scope and will result in claim reversal.
Billing Tips
- Ensure the written referral is physically present or clearly noted in the common medical record before the service is rendered to satisfy the mandatory consultation requirement.
- When calculating time for W695, strictly exclude non-patient-facing activities like chart review or report writing, as only face-to-face time with the patient is billable.
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 long-term care institution with a common medical record, 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 start and stop times must be recorded in the patient’s permanent medical record.
Adult
Subject to same conditions as A695.
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