W872 – Palliative care
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit for the provision of palliative care to a patient in a long-term care 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, but not to patients in designated palliative care beds (who are covered by C882/C982). Palliative care is defined as 'care provided to a terminally ill patient in the final year of life where the decision has been made that there will be no aggressive treatment of the underlying disease and care is to be directed to maintaining the comfort of the patient until death occurs' (Source: ). As an assessment, this service includes all specific elements of assessments (Source: ), such as a direct physical encounter, history taking, physical examination, arranging related procedures, and providing advice to the patient. It also includes all common elements applicable to insured services (Source: , ).
When to Use
- Use W872 for a subsequent palliative care visit in a nursing home or home for the aged when the patient is not in a designated palliative care bed.
- Use this code for routine comfort-focused assessments for a terminally ill patient when you are not the physician claiming the W010 monthly management fee for that month.
Common Pitfalls
- Billing W872 when you have already claimed W010 for the same patient in the same calendar month, as W872 is strictly included in the monthly management fee.
- Attempting to use W872 for patients in designated palliative care beds, which must be billed under C882 or C982 instead.
- Failing to distinguish between palliative comfort care and acute intercurrent illness, as the latter should be billed under W121 rather than W872.
Billing Tips
- If you are the primary physician managing the patient, ensure you are not billing W872 separately if you have already submitted W010 for that patient in the same month.
- Always verify the patient's bed designation status in the facility, as the exclusion of designated palliative care beds is a common audit trigger for code misapplication.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
Standard medical record requirements for an assessment must be met as per the Schedule of Benefits.
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