W864 – Not found
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Type 2 admission assessment occurs when the admitting physician makes an initial visit to assess the condition of the patient following admission to a long-term care institution, and has previously rendered a consultation, general assessment or general re-assessment of the patient prior to admission. This service is applicable to patients in Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, and designated chronic or convalescent care beds in hospitals, excluding designated palliative care beds (see and ).
When to Use
- Use W864 when you perform an admission assessment for a patient in a long-term care facility if you have already completed a comprehensive assessment or consultation for that patient prior to their admission.
- Use this code for initial visits to chronic or convalescent care beds when the patient's medical history and current status have been previously established by you through a general assessment or re-assessment.
Common Pitfalls
- Billing W864 in the same calendar month as W010 will result in a rejection, as the admission assessment is considered inclusive of the monthly management fee.
- Submitting W864 without clear documentation of a prior consultation or general assessment in the patient's chart will trigger an audit recovery, as the 'Type 2' status is contingent on this prior relationship.
Billing Tips
- Ensure your clinical notes explicitly reference the date and nature of the prior consultation or general assessment to justify the use of the Type 2 fee over a Type 1 assessment.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
All assessments must include the specific elements: a direct physical encounter with the patient including taking a patient history and performing a physical examination.
The medical record must substantiate that the physician has previously rendered a consultation, general assessment, or general re-assessment of the patient prior to this admission assessment.
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