W998 – First person seen - Long-Term Care Institution - Nights
OHIP Neurology Code — GENERAL PREAMBLE · Schedule of Benefits
This is a 'first person seen' special visit premium. It is payable for a non-elective visit to a patient in a Long-Term Care Institution, initiated by the patient or their representative. This specific premium applies when the service is rendered during Nights (00:00-07:00). As per , claims should be submitted using the appropriate A-prefix assessment fee from the 'General Listings' for the assessment rendered in conjunction with this premium. The time of the visit must be documented in the patient's medical record.
When to Use
- Use W998 when you are called to a long-term care facility between 00:00 and 07:00 for an urgent, non-elective assessment of a single patient.
- Apply this code when the visit is initiated by nursing staff or the patient's representative specifically for an acute clinical change that cannot wait until morning rounds.
Common Pitfalls
- Billing W998 for subsequent patients seen during the same trip; only the first patient seen qualifies for the 'first person' premium, while others must be billed as W999.
- Submitting W998 for routine or elective visits, which are strictly prohibited under GP66 and will trigger audit recovery.
- Failing to document the exact time of the visit in the chart, which is a mandatory requirement under GP69 for all special visit premiums.
Billing Tips
- Always pair W998 with an A-prefix assessment code (e.g., A007) to ensure the claim is processed correctly according to the General Preamble requirements.
- If you see multiple patients during the same night call, ensure the first patient is billed with W998 and subsequent patients are billed with W999 to avoid rejection for duplicate premium codes.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Premium
Special Visit Premiums (Table IV - Long-Term Care Institution)
The time at which the special visit takes place must be documented on the medical record.
If a physician is called to a nursing home to see a patient for a non-elective problem at 8AM, and subsequently sees his/her routine patients on rounds, those additional patients do not qualify for the additional person premium.
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