W845 – Limited consultation
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation is a consultation which is less demanding and, in terms of time, normally requires substantially less of the physician's time than the full consultation. Otherwise, a limited consultation has the same requirements as a full consultation. This service is rendered in a non-emergency long-term care setting, which includes 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 with all consultations, it requires a written request from a referring physician, nurse practitioner, or dental surgeon.
When to Use
- Use W845 for a specialist consultation in a long-term care facility when the clinical complexity or time required does not meet the threshold for a full consultation (W445).
- Use this code when providing a focused opinion on a specific geriatric issue, such as medication review or mobility assessment, upon written request from the attending physician.
Common Pitfalls
- Claiming W845 without a formal written referral request in the chart, which will lead to a clawback to a lower assessment fee during an audit.
- Attempting to bill special visit premiums with W845; these are strictly prohibited for 'W' prefix codes and will be rejected.
Billing Tips
- Ensure the referral note explicitly states the reason for the consultation to distinguish it from a routine follow-up assessment (W765).
- If the patient is in a designated palliative care bed, W845 is ineligible; use the appropriate palliative care assessment codes instead.
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, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
The request identifies the consultant by name, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
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