W849 – Periodic health visit
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A periodic health visit, as defined on page , performed for a patient in a non-emergency long-term care institution. This service is for a patient, after their second birthday, who presents with no apparent acute physical or mental illness. It must include an intermediate assessment, a level 2 paediatric assessment, or a partial assessment focusing on age and gender appropriate history, physical examination, health screening, and relevant counselling. 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, as per page .
When to Use
- Use W849 for the annual comprehensive health review of a patient residing in a long-term care facility who is asymptomatic and requires age-appropriate screening.
- Use this code when performing a scheduled wellness examination for a patient over age two in a designated chronic or convalescent care bed where no acute illness is present.
Common Pitfalls
- Billing W849 for a patient who presents with an acute physical or mental illness, which instead requires a standard visit code like W444.
- Submitting W849 more frequently than the allowed annual frequency, which will trigger automatic rejections or audit flags.
- Attempting to claim W444 within six months of a W849, as the Ministry enforces a strict interval between these specific assessment types.
Billing Tips
- Ensure the clinical note explicitly documents the age and gender-appropriate screening components to satisfy the requirements of an intermediate or partial assessment.
- Verify the facility status of the patient, as W849 is restricted to specific institutional settings defined in A134 and cannot be used for community-based patients.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
The service must include an intermediate assessment, a level 2 paediatric assessment or a partial assessment focusing on age and gender appropriate history, physical examination, health screening and relevant counselling.
Patient must be after their second birthday
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