1What Is the W220 OHIP Code?
What is W220?
W220 is a specialized OHIP billing code used for conducting detailed genetic consultations for residents in non-emergency long-term care settings. This typically applies to chronic care hospitals, nursing homes, and homes for the aged. The service involves a comprehensive assessment where the physician spends at least 75 minutes in direct contact with the patient or their family.
The primary aim of these consultations is to clarify complex inherited diagnoses that might influence ongoing care strategies and family counseling. Due to the depth of evaluation required, this service differs from standard consultations and demands a significantly longer period of direct physician-patient interaction.
Genetic consultations can often be overlooked due to misinterpretation of eligibility criteria or documentation requirements, leading to missed billing opportunities.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A220 | Special genetic consultation | once per two consecutive 12-month periods | Standard counterpart of W220 for outpatients. |
| A223 | Extended special genetic consultation | varied based on patient complexity | Used for extended sessions requiring more than 75 minutes of direct contact. |
| A225 | Consultation | limited as per specialty requirements | Standard genetic consultation for less complex cases. |
| A226 | Repeat consultation | as needed for ongoing management | Follow-up consultations for previously seen patients. |
3Eligibility Requirements
Eligibility for W220
To bill for W220 under OHIP, the following criteria must be met:
- Setting: The consultation must occur in a non-emergency long-term care setting, such as a chronic care hospital or nursing home.
- Duration: The physician must spend a minimum of 75 minutes in direct contact with the patient or family.
- Documentation: Start and stop times must be recorded in the patient's permanent medical record.
- Referrals: A written request for the consultation must be obtained from a physician, nurse practitioner, or dental surgeon and documented appropriately, including all identifying information of the parties involved.
This service can only be billed once per two consecutive 12-month periods per patient, unless the diagnosis changes or if the second consultation occurs in a hospital for different conditions after 12 months.
4What Your Clinical Note Must Show
The start and stop times of the consultation must be clearly recorded.
- Record the exact start time of the consultation.
- Record the exact stop time of the consultation.
A documented referral must be present.
- Store a copy of the written referral request in the patient record.
- Ensure the referral includes all necessary identifiers and specifications.
5Weak vs. Strong Note Examples
The strong note successfully demonstrates compliance with OHIP requirements by providing detailed time records and a clear context for the genetic consultation, while the weak note lacks specificity and essential documentation.
Genetic consultation completed.
Conducted a special genetic consultation to clarify a suspected inherited diagnosis for the patient.
- Session started at 14:00 and ended at 15:20.
- Referral request from Dr. Smith, documented and retained.
- Patient presented with family history of genetic disorder X requiring detailed evaluation.
