W903 – Pre-dental/pre-operative general assessment
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A pre-dental or pre-operative assessment rendered to a patient in a long-term care institution, which includes chronic care hospitals, convalescent hospitals, nursing homes, or homes for the aged. The 'W' prefix designates this as a non-emergency in-patient service (, ). This service is a component of the W010 (Monthly Management of a Nursing Home or Home for the Aged Patient) and is not separately payable if W010 is claimed for the same patient in the same calendar month (). This service is eligible for a 15% age premium when rendered to patients aged 65 and over ().
When to Use
- Use W903 when performing a pre-operative medical clearance for a patient residing in a long-term care facility who is scheduled for a dental or surgical procedure.
- Use this code for patients in convalescent hospitals or homes for the aged when the service is not part of the physician's routine monthly management (W010).
Common Pitfalls
- Billing W903 in the same calendar month as W010 will trigger an automatic rejection, as the monthly management fee is inclusive of pre-operative assessments.
- Failing to apply the 15% age premium for patients aged 65 and over results in significant under-billing for this service.
Billing Tips
- Verify the patient's W010 billing status for the current month before submitting W903 to avoid unnecessary claim rejections.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
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