1What Is the W190 OHIP Code?
Definition
The W190 billing code is used for special psychiatric consultations in Ontario, Canada. This is a specialized consultation where the psychiatrist provides all elements of a typical consultation but engages in a minimum of 75 minutes of direct patient interaction. It is designed for complex psychiatric evaluations, such as for patients with intricate psychiatric or neuropsychiatric issues.
Clinical Context
Special psychiatric consultations are often required in scenarios where the patient presents with complex psychiatric conditions that may involve differential diagnoses including dementia, delirium, depression, or behavioral issues in later life. A common scenario is assessing long-term care in-patients with escalating behavioral concerns, where the psychiatrist must untangle multiple overlapping factors before treatment can be justified.
Commonly Missed Details
One critical requirement for this billing code is the 75-minute minimum of direct patient contact. It's important for physicians to remember that time spent reviewing the patient's chart or speaking with non-patient facility staff does not count towards these 75 minutes.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A190 | Special psychiatric consultation | Same as W190 | Used under similar conditions as W190. |
| A195 | Consultation | As required | Standard psychiatric consultation, less time-intensive than W190. |
| A196 | Repeat consultation | As required within 12 months | For follow-up consultations with patients. |
| A395 | Limited consultation | As required | For less comprehensive consultations. |
3Eligibility Requirements
Eligibility Requirements
- Billing Frequency: W190 can be claimed for the same patient, by the same physician, and for the same diagnosis only once per two consecutive 12-month periods. An exception allows for two services in two consecutive 12-month periods if the second consultation is more than 12 but less than 24 months after the first, provided it occurs with an inpatient or in an Emergency Department.
- Unrelated Diagnosis: For clearly unrelated diagnoses, W190 can be billed once every 12 months without restriction.
- Service Limits: Any services rendered in excess of these amounts will be remunerated at a general or specific assessment rate.
- Virtual Delivery: W190 can be rendered via video and billed as W190A, but phone consultations are ineligible.
- Special Notes: When submitting claims, include appropriate special visit premium codes for in-patient, long-term care, or Emergency Department consultations. Ensure 75 minutes of direct patient contact is fulfilled.
4What Your Clinical Note Must Show
Ensure comprehensive documentation to support the W190 billing, highlighting the need for and complexity of the psychiatric consultation.
- Patient's presenting complaint and psychiatric history.
- Summary of the differential diagnosis considered.
- Detailed account of the patient interaction, with emphasis on the direct contact duration.
- Conclusion reached and the treatment strategy developed.
- Any follow-up or continued care recommendations.
5Weak vs. Strong Note Examples
The strong note succeeds by clearly outlining the diagnostic process and management plan, while documenting the required 75 minutes of direct patient contact. The weak note lacks detail on the assessment and fails to substantiate the time spent.
Consult conducted, patient presented with depression. Discussed potential treatment options. Time spent: 75 minutes.
Patient referred for evaluation due to severe depression with recent functional decline. Reviewed history and current medications.
Conducted mental status examination and assessed overlapping conditions such as medication effects and potential dementia.
Provided comprehensive feedback on findings and developed a detailed management plan.
- Minimum 75 minutes direct contact documented.
- Clear differential diagnosis process described.
- Integration of patient history and examination into the management plan.
