W760 – Complex endocrine neoplastic disease assessment
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A complex endocrine neoplastic disease assessment rendered in a non-emergency long-term care in-patient setting. These settings include 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. As stated on , this service is subject to the same conditions as A760. As an assessment, it includes the specific elements outlined in , which involve a direct physical encounter with the patient, history taking, physical examination, and arranging for any related care or procedures.
When to Use
- Use W760 for a comprehensive assessment of a patient with complex endocrine neoplasia, such as multiple endocrine neoplasia (MEN) syndromes or metastatic thyroid carcinoma, residing in a long-term care facility.
- Select this code when performing a periodic complex re-assessment for a patient with stable but high-acuity endocrine malignancy that requires ongoing monitoring of systemic complications.
Common Pitfalls
- Claiming W760 in the same month as the monthly management fee W010 will result in an automatic rejection, as the management fee is intended to cover routine care.
- Billing W760 for patients in designated palliative care beds is prohibited and will trigger an audit, as these patients fall under different funding structures.
- Using W760 for uncomplicated endocrine disorders, such as routine hypothyroidism or stable type 2 diabetes, is an inappropriate use of the code and risks clawbacks.
Billing Tips
- Ensure the clinical documentation explicitly details the complexity of the neoplastic disease to justify the use of this specific assessment code over a standard W010 visit.
- If an emergency arises, do not use W760; instead, bill A760 in conjunction with the appropriate Special Visit Premium to ensure proper compensation for urgent care.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
Must include the elements of a medical specific re-assessment.
Subject to the same conditions as A760
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