W869 – Periodic health visit
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A periodic health visit (including a primary or secondary school examination) performed on a patient, after their second birthday, who presents and reveals no apparent acute physical or mental illness, as defined in the Schedule on page . 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. It applies to non-emergency services in settings such as 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.
When to Use
- Use W869 for routine annual health maintenance exams for patients residing in long-term care facilities who are over the age of two.
- Apply this code when performing a scheduled, non-acute physical examination for a resident in a nursing home or home for the aged that does not involve the monthly management fee (W010).
Common Pitfalls
- Billing W869 in the same month as W010 will result in an automatic rejection, as the periodic health visit is considered a component of the monthly management fee.
- Submitting W869 more than once in a 12-month period per physician will trigger a payment adjustment or rejection, as it is limited to one per year.
Billing Tips
- Ensure the patient is not in a designated palliative care bed, as W869 is specifically excluded for those patients.
- Verify the patient's age is over two years at the time of service to avoid eligibility rejections.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, 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.
Performed on a patient after their second birthday.
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