W862 – Admission Assessment - Type 1
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Type 1 admission assessment is defined in as a general assessment rendered to a patient on admission to a non-emergency long-term care facility. The assessment requires the components of a full general assessment as described on . This service is billable for patients in: - Chronic Care Hospitals - Convalescent Hospitals - Nursing Homes - Homes for the Aged - Designated chronic or convalescent care beds in hospitals (excluding designated palliative care beds). If the physician has rendered a consultation, general assessment, or general re-assessment of the patient prior to admission, the amount payable for this service will be adjusted to a lesser fee, such as W864 (Type 2 admission assessment).
When to Use
- Use W862 for the initial comprehensive admission assessment when a patient is first admitted to a chronic care hospital, nursing home, or home for the aged.
- Select W862 when performing a full general assessment (as defined in GP21) specifically for a patient entering a non-emergency long-term care bed.
Common Pitfalls
- Billing W862 when a consultation or general assessment was already performed by the same physician shortly before admission, which mandates the use of the lower-valued W864.
- Attempting to claim special visit premiums with W862, which is strictly prohibited as this code is intended for scheduled admission assessments, not emergency or urgent calls.
Billing Tips
- Ensure the clinical record explicitly documents a full systems review and physical examination to meet the GP21 requirements, as this is the primary documentation target for OHIP audits of W862.
- If the patient is in a designated palliative care bed, W862 is not applicable; use the appropriate palliative care assessment codes instead.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
Requires a full history (presenting complaint, family medical history, past medical history, social history, and a functional inquiry into all body parts and systems) and an examination of all body parts and systems, except for breast, genital or rectal examination where not medically indicated or refused.
Non-Emergency Long-Term Care In-Patient Services includes Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, designated chronic or convalescent care beds in hospitals and nursing homes or homes for the aged, other than patients in designated palliative care beds.
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
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