1What Is the W226 OHIP Code?
The W226 billing code allows medical geneticists to charge for repeat consultations. This service is particularly beneficial when a change in family medical history, such as new genetic test results from a relative, necessitates reevaluation of the patient's genetic diagnosis. Healthcare providers in chronic care settings often encounter scenarios where ongoing or recently modified information about inherited conditions affects the treatment or understanding of long-term residents.
Despite its importance, physicians frequently overlook billing W226 due to confusion around documentation or the necessity of a new referral. Ensure compliance with the new written request requirement to maximize billing efficiency.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A220 | Special genetic consultation | One time | This code is applicable for complex genetic consultations requiring in-depth assessment. |
| A223 | Extended special genetic consultation | One time | Utilized for lengthier and more detailed genetic consultations that extend beyond regular session durations. |
| A225 | Consultation | One time | For initial genetic consultations requiring comprehensive evaluation. |
| A226 | Repeat consultation | As required | Applicable for revisiting previous evaluations based on updated patient information. |
3Eligibility Requirements
Under the OHIP Schedule of Benefits, W226 applies to non-emergency long-term care in-patient services, including chronic care hospitals, nursing homes, and designated chronic care beds. A written request signed by a referring physician, nurse practitioner, or dental surgeon must be kept in the consulting physician's medical record, unless a shared medical record system applies. The code provides exceptions from consultation frequency limits outlined in GP17 and requires a new referral for each repeat service. Note, however, claims will be denied if genetic care with code K222 has been previously charged by the same consultant.
4What Your Clinical Note Must Show
Maintain a copy of the referral in the patient's medical record.
- Written request by referring professional
- Signature of the referring physician, nurse practitioner, or dental surgeon
- Ensure document accessibility in shared medical record systems when applicable
5Weak vs. Strong Note Examples
The strong note clearly details the context and specifics of the consultation, referencing both patient history and the discussion process, unlike the weak note which lacks specifics.
Repeat consultation performed due to family history changes.
Patient seen for repeat genetic consultation due to recent familial test results indicating BRCA mutation. Detailed family history and implications discussed.
- Familial results reviewed: significant genetic mutation discovered
- Patient concerns addressed: inheritance patterns and risk management recommendations
