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OHIP Billing Guide🩺 ServicePublished 2026
W355

W355 OHIP Billing Code: Urology Consultation for Long-Term Care

W355 covers urology consultations in non-emergency long-term care settings, primarily for addressing complex or recurring urological issues.

For Ontario Physicians & Billing StaffOHIP Schedule of Benefits Reference93.15 CAD~3 min read

1What Is the W355 OHIP Code?

What is W355?

The W355 OHIP billing code is used for consultations provided by urologists in non-emergency long-term care settings, such as chronic care hospitals, nursing homes, or homes for the aged. This service is crucial for managing complex urological conditions that are not feasible for treatment in a traditional clinic setting, such as recurrent catheter issues or urinary retention.

Urology consultations are often missed in cases where documentation is incomplete or when the service does not meet eligibility criteria for a consultation. Ensuring proper referral requests and documentation can help avoid these pitfalls.

2Related Codes

CodeNameFrequencyDescription
A935Special surgical consultationas neededHigher complexity surgical consultation in the Urology listings.
C935Special surgical consultationas neededHigher complexity surgical consultation in the Urology listings.
A355Consultationsame patient, same physician, same diagnosis: one service per two consecutive 12-month periodsStandard consultation in the Urology listings similar to W355.
A356Repeat consultationas neededFollow-up consultation for recurring urological issues.

3Eligibility Requirements

Eligibility Requirements

To bill using W355:

  • The service must be rendered in non-emergency, long-term care settings such as chronic care hospitals or nursing homes, excluding designated palliative care beds.
  • A written request for consultation must be received from a physician, nurse practitioner, or dental surgeon.
  • The request must include identifiers for the consultant, the referring professional, and the patient, along with a detailed description of the required services.
  • Services rendered in excess of the limits specified will be paid at a general or specific assessment rate.

4What Your Clinical Note Must Show

1Documentation Requirements

Ensure the following documentation is present for billing W355:

  • A written request from a referring professional with all parties identified by name and relevant billing numbers.
  • A detailed report from the consulting physician to the referring professional.
  • Documentation of the consultation start and end times.

5Weak vs. Strong Note Examples

The strong note succeeds by providing complete referral details, specifics of the case, and a thorough summary, which the weak note lacks.

❌ Weak Note

Patient seen for catheter issues. Consulted by Dr. Smith. Follow-up recommended.

✓ Strong Note

Consultation requested by Dr. Brown, NP, on March 5, 2023, for recurrent catheter obstruction in a patient resident at Sunshine Nursing Home. Duration of consultation: 14:00-14:45.

Assessment showed catheter blockage due to sediment accumulation. Recommendations include catheter change protocol adjustments and dietary modifications to decrease calcium intake.

  • Date and Duration of Consultation: March 5, 2023, 14:00-14:45.
  • Referring professional: Dr. Brown (NP), Billing #123456.
  • Consulting physician: Dr. Smith (Urology).

6Common Reasons This Code Is Missed

1
Incomplete Written Request
Consultation requests lacking necessary details such as billing numbers and service specifics.
2
Documentation Omissions
Failure to document start and end times of the consultation can lead to denied claims.
3
Incorrect Setting
Billing for consultations conducted outside eligible long-term care settings.
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8Frequently Asked Questions

What is the fee for billing code W355?
The fee for W355 is CAD 93.15.
How often can W355 be billed by the same physician for the same patient?
It can be billed once per two consecutive 12-month periods for the same diagnosis, with specific exceptions.
What types of urological issues might justify a W355 consultation?
Recurrent catheter problems or retention, typical in long-term care settings, often qualify.
Why might a urologist prefer a W355 consultation over a standard clinic visit?
Due to patient mobility issues or the complexity of managing conditions in residents of long-term care facilities.
How can a urologist qualify a case for a W355 consultation instead of a standard assessment?
By demonstrating the complexity or recurrences of urological conditions that require specialist intervention.
Can W355 be billed if the service was provided virtually?
Yes, if the service was delivered via video; it should be billed as W355A.
When might a patient be referred to a urologist for a W355 consultation?
Patients with chronic or complex urological issues that can't be managed in a traditional clinic setting.
What should be included in the report to the referring professional?
Findings, opinions, and recommendations based on the consultation.
Disclaimer: This article is intended as a general educational resource for physicians and billing staff. It does not constitute billing advice or a definitive interpretation of the OHIP Schedule of Benefits. Always verify current billing codes, eligibility criteria, and documentation requirements directly against the official Schedule of Benefits or consult with a qualified medical billing specialist.
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