1What Is the W185 OHIP Code?
The W185 OHIP billing code pertains to standard consultations provided by neurologists in Ontario. It is specifically designed for use in long-term care settings where a resident presents with a focused neurological question, such as a new tremor, a single seizure episode, or a medication side effect suspected of causing parkinsonism. This code is ideal for cases that don't require the extensive diagnostic workup associated with more complex consultations like the W180 special neurology consultation.
One common reason the W185 code is missed by practitioners is due to its specific application in long-term care settings and its distinction from similar consultations like C185 for hospital in-patient settings or A185 for office visits. Awareness of these specific use cases ensures proper billing and avoids claim rejections.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A180 | Special neurology consultation | As clinically necessary | For comprehensive issues requiring extensive workup. |
| A185 | Consultation | One service per consultation per patient | Standard office consultation. |
| A186 | Repeat consultation | Per repeat consultation as required | Follow-up consultations requiring additional assessment. |
| A385 | Limited consultation | As clinically necessary | For narrow, specific consultation needs. |
3Eligibility Requirements
The W185 code may be rendered virtually under the condition that it is delivered via video, not telephone. Neurologists can bill this code once per two consecutive 12-month periods for the same patient under the same diagnosis. In situations where the second consultation is conducted with a hospital inpatient or an Emergency Department patient, it can be billed more than 12 but less than 24 months after the first consultation.
Importantly, if the diagnosis is unrelated to the previous consultation, the W185 can be billed once every 12 months. Should services exceed these parameters, they are compensated at the general or specific assessment rates.
Eligibility also notes that this code should only be claimed six months following a Periodic Health Visit, as per the Nursing Homes Act.
4What Your Clinical Note Must Show
Ensure your medical records accurately reflect the reason for consultation and patient status. Include details such as:
- Consultation request and reason.
- Patient's neurological complaint.
- Assessment details exclusive to a long-term care context.
- Summary of findings and clinical decision-making.
5Weak vs. Strong Note Examples
The strong note succeeds because it provides a complete clinical picture, clearly outlines the specialist's thought process, and includes specific follow-up actions. The weak note lacks detail and fails to justify the consultation's necessity.
Patient presented with mild tremor. Consult requested by nursing staff. Reviewed medications. Plan discussed.
Patient, a 75-year-old with a two-week history of increasing unilateral tremor, referred from staff at Long-Term Care facility.
Detailed review of current medications conducted, suspecting parkinsonism as a side effect.
Held comprehensive neurological exam confirming findings, with a plan for medication adjustment if no improvement in two weeks.
- Comprehensive examination findings.
- Detailed narrative of clinical reasoning.
- Specific follow-up actions with time frames.
