1What Is the W105 OHIP Code?
The W105 OHIP billing code is utilized by family physicians to bill for consultations when a formal and comprehensive assessment is needed. This often occurs in long-term care settings, such as nursing homes, where a resident may experience changes in cognition, recurrent falls, or a need for goals-of-care discussions. These circumstances warrant a full consultative assessment rather than a routine visit.
Physicians may underutilize this code due to unfamiliarity with the specific conditions required for its use or confusion about the distinction between consultations and general assessments.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A914 | GP focused practice comprehensive consultation by Video | As determined by service requirements | Video consultation offering comprehensive assessment in focused practice. |
| A006 | Repeat consultation | As needed based on patient care | Used for repeat consultations without additional comprehensive needs. |
| A010 | GP focused practice consultation by Video | Based on specific requirements | Service via video for consultation within general practice. |
| A011 | GP focused practice repeat consultation by Video | According to clinical requirements | Videoconference-based repeat consultation. |
3Eligibility Requirements
Eligibility for billing W105 under OHIP includes:
- Frequency: Same patient, same physician, same diagnosis: one service per two consecutive 12-month periods. An exception allows for two services if the second is rendered to a hospital inpatient or patient in an Emergency Department more than 12 but less than 24 months after the first. If a clearly defined unrelated diagnosis arises, one service is allowed every 12 months.
- Settings: Typically involves consultations by family physicians in a long-term care facility.
- Diagnostic Clarity: Consultations involve significant diagnostic clarity as these usually result in forming or revising a care plan.
4What Your Clinical Note Must Show
Ensure the following are recorded accurately in the patient's medical record to justify billing for W105:
- Detailed description of the patient's condition requiring consultation
- Comprehensive assessment findings and diagnostic conclusions
- Recommendations and treatment plan adjustments made as a result of the consultation
- Date and setting of consultation including referral source, if applicable
5Weak vs. Strong Note Examples
The strong note provides a complete picture of the consultation, demonstrating thorough assessment and clinical reasoning that supports the billing. The weak note lacks detail and specificity.
Seen patient with recurrent falls. Made recommendations.
Conducted a comprehensive assessment on the patient's recurrent falls.
Discussed and clarified the goals-of-care with the nursing home staff and family, and adjustments to the medication regimen were made in response to the change in cognition.
- Patient complained of increased instances of falls over the past month.
- Differential diagnosis included orthostatic hypotension and possible medication side effects.
- Reviewed current medications and adjusted dosages accordingly.
- Family and staff were informed about the new care strategy.
