W895 – Psychiatric Consultation - Non-Emergency Long-Term Care In-Patient
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A psychiatric consultation provided for a patient in a Long-Term Care Institution (Chronic Care Hospital, Convalescent Hospital, Nursing Home, Home for the Aged, or designated chronic/convalescent care beds). This service is rendered following a written request from a referring physician, nurse practitioner, or dental surgeon for the opinion of a specialist. It includes a general, specific, or medical specific assessment, a review of all relevant data, and the preparation of a written report to the referring practitioner.
When to Use
- Use W895 when performing a formal psychiatric consultation for a patient in a long-term care facility following a written request from a referring physician or nurse practitioner.
- Select W895 instead of a standard psychiatric assessment code when the service is specifically requested to provide a specialist opinion on a patient residing in a chronic care or nursing home setting.
Common Pitfalls
- Billing W895 without a documented written request from the referring practitioner will result in a clawback to a lesser assessment fee during an audit.
- Failing to include the referring practitioner's billing number in the consultation report or medical record is a frequent cause for rejection.
- Attempting to bill W895 for routine follow-up visits or ongoing management; this code is strictly for the initial consultation opinion.
Billing Tips
- Always append the age premium for patients 65 and older to maximize the claim value, as this is a specialist consultation.
- If the consultation exceeds the standard time allotted, ensure you bill K630 to capture the additional time spent with the patient or their caregivers on the same day.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
A copy of the written request for the consultation, signed by the referring practitioner, must be kept in the consulting physician's medical record. In settings with common medical records, the written request may be on the common record.
The request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number.
The written request must set out information relevant to the referral and specify the service(s) required.
The consultant must prepare a written report (including findings, opinions, and recommendations) for the referring practitioner.
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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