W912 – Comprehensive family and general practice consultation
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A comprehensive consultation for a patient in a long-term care institution, rendered by a physician in Family Practice & Practice in General (specialty 00). This service is subject to the same conditions as A912. It is intended for complex, serious, or obscure cases requiring an assessment of greater scope and time than a standard consultation (e.g., W535). It requires a written request from a referring practitioner and a written report back, as per general consultation requirements (). The 'W' prefix designates this service for non-emergency in-patients in facilities such as chronic care hospitals, convalescent hospitals, nursing homes, and homes for the aged (, A150).
When to Use
- Use W912 when a complex, multi-system assessment is required for a long-term care patient that exceeds the scope of a standard W535 assessment.
- Utilize this code for a formal consultation request from a referring practitioner regarding a patient's management plan in a nursing home or chronic care facility.
- Select W912 when the clinical complexity necessitates a comprehensive review of the patient's history and current status, provided the formal referral and reporting requirements of GP16 are met.
Common Pitfalls
- Billing W912 without a documented, written referral request from the referring practitioner, which will trigger a downgrade to a lower-paying assessment code upon audit.
- Failing to provide a formal written report back to the referring practitioner, as this is a mandatory requirement for all consultation codes including W912.
- Attempting to bill W912 for ongoing management of a patient previously seen for the same diagnosis, which violates the restriction against using consultation codes for follow-up care.
Billing Tips
- Ensure the referral request explicitly names both the consultant and the referring practitioner to satisfy the strict documentation requirements of GP16.
- Always verify that the patient is in a qualifying long-term care institution, as W912 is strictly reserved for these settings, unlike the community-based A912.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Hospital and Institutional Consultations and Assessments
A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician's medical record. In a long-term care institution where common medical records are maintained, the written request may be contained on the common medical 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 the information relevant to the referral and specify the service(s) required.
The consultant must prepare a written report, including findings, opinions, and recommendations, to the referring practitioner.
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.