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W999
W999 – Additional person(s) seen - Long-Term Care Institution - Nights
OHIP Neurology Code — GENERAL PREAMBLE · Schedule of Benefits
An additional person premium is payable for services rendered to additional patients seen in long-term care institutions, provided that each additional patient service is commenced during an eligible time. For W999, the eligible time is Saturdays, Sundays, and Holidays from 00:00 to 07:00. This premium is paid in addition to an appropriate assessment fee (claimed with an 'A' prefix) for the additional patient. A special visit is defined as a visit initiated by a patient or an individual on behalf of the patient for the purpose of rendering a non-elective service.
When to Use
- Use W999 when you are called to a long-term care facility for a non-elective assessment on a weekend or holiday between 00:00 and 07:00 and you see a second or subsequent patient during that same trip.
- Apply this code when the initial patient visit qualifies for the W963 premium and you perform a medically necessary assessment on a second patient during the same visit window.
Common Pitfalls
- Billing W999 for routine rounds or elective follow-ups performed during the same trip as a non-elective call is a common audit trigger and will be rejected.
- Claiming W999 when the service is provided during your standard, pre-scheduled nursing home rounds, even if those rounds occur on a weekend or holiday, is ineligible.
- Failing to link the W999 to a valid A-prefix assessment fee for the additional patient will result in an automatic claim rejection.
Billing Tips
- Always ensure the primary patient visit is billed with W963 to establish the 'special visit' status before appending W999 for the additional patient(s) seen during the same trip.
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