W842 – Admission assessment - Type 1
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Type 1 admission assessment is a general assessment rendered to a patient on admission to a non-emergency long-term care setting. As per and , this service applies to patients in chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent care beds in hospitals. A general assessment, as defined in , requires: - A full history (including history of the presenting complaint, family medical history, past medical history, social history, and a functional inquiry into all body parts and systems). - An examination of all body parts and systems (except for breast, genital or rectal examination where not medically indicated or refused). - It may include a detailed examination of one or more parts or systems.
When to Use
- Use W842 when performing the initial comprehensive admission assessment for a patient newly admitted to a chronic care facility, nursing home, or home for the aged.
- Use this code for the first formal assessment of a patient transferred into a designated convalescent care bed, provided the documentation meets the full GP21 general assessment criteria.
Common Pitfalls
- Billing W842 when the patient has already received a consultation or general assessment from you within the same facility or clinical episode, which triggers an automatic adjustment to a lower-valued assessment code.
- Failing to document a full systems review or functional inquiry, which leads to audit rejections as W842 requires the same rigor as a standard GP21 general assessment.
- Exceeding the 12-month frequency limit without documenting a distinct diagnosis or waiting the required 90-day interval for a new admission assessment.
Billing Tips
- Ensure your chart note explicitly labels the encounter as an 'Admission Assessment' and includes a comprehensive systems review to distinguish it from a routine W845 or W847 follow-up visit.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
A general assessment requires documentation of a full history (presenting complaint, family, past, social, functional inquiry) and a full systems examination.
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