W867 – Admission Assessment - Type 3
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Type 3 admission assessment is a general re-assessment of a patient who is re-admitted to the long-term care institution after a minimum 3 day stay in another institution. 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 (other than patients in designated palliative care beds). A general re-assessment includes all the services listed for a general assessment, with the exception of the patient's history, which need not include all the details already obtained in the original assessment. This code is listed under the Nephrology specialty.
When to Use
- Use W867 when a patient returns to a long-term care facility after an acute care hospital stay of at least 3 days to perform a comprehensive re-assessment.
- Apply this code for patients transferring back from a hospital stay that exceeds the 72-hour threshold, provided you are not the MRP claiming the W010 monthly management fee.
Common Pitfalls
- Billing W867 while also claiming the W010 monthly management fee will result in an automatic rejection, as the assessment is considered inclusive of the management fee.
- Attempting to use W867 for patients in designated palliative care beds is prohibited and will lead to audit recovery, as these beds are explicitly excluded from this code's scope.
Billing Tips
- Ensure the patient's hospital stay duration is documented as 3 days or more to satisfy the specific eligibility criteria for this re-admission assessment.
- If you are the MRP, do not bill W867; instead, incorporate the re-assessment work into your routine monthly management billing under W010.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
This service is for non-emergency services in Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, or designated chronic or convalescent care beds in hospitals, excluding 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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