W904 – Pre-dental/pre-operative assessment
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A pre-dental or pre-operative partial assessment for a patient located in a Long-Term Care Institution, which includes chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent care beds in hospitals (). This service constitutes a partial assessment, defined as a limited service that includes a history of the presenting complaint, the necessary physical examination, advice to the patient, and an appropriate record (). It is performed prior to a dental or surgical procedure. As with all assessments, it includes the specific elements outlined on .
When to Use
- Use W904 when performing a focused pre-operative clearance for a patient in a long-term care facility who is scheduled for an elective surgical procedure.
- Use W904 for a pre-dental assessment required for a nursing home resident prior to an invasive dental procedure, provided the service is not part of the monthly management fee.
Common Pitfalls
- Billing W904 in the same calendar month as W010 is a common rejection, as the Ministry considers pre-operative assessments to be included in the monthly management fee.
- Submitting W904 for a patient in an acute care hospital bed is incorrect; it is strictly limited to chronic care, convalescent, or nursing home settings as defined in GP49.
Billing Tips
- Ensure the clinical note explicitly states the procedure for which the patient is being cleared, as this distinguishes the service from a routine visit or W010 management.
Effective: September 1, 2011
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
In accordance with the definition of a partial assessment on , the medical record must contain a history of the presenting complaint, the necessary physical examination, and the advice given to the patient.
As an assessment, the service must be documented in the patient's medical record, including evidence of a direct physical encounter with the patient and other applicable specific elements of assessments as described on .
The 'W' prefix indicates this service is for non-emergency in-patient services for patients in chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged and designated chronic or convalescent care beds in hospitals ().
Commentary in the Schedule of Benefits () indicates that the full definition and terms and conditions for pre-dental/pre-operative assessments are found on page , which was not included in the provided context.
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