1What Is the W385 OHIP Code?
The W385 billing code is designated for limited neurological consultations provided to long-term care in-patients. This service addresses specific, narrow questions, such as evaluating an abnormal neurological finding or assessing the potential neurological side effects of a medication. Unlike full consultations, a W385 service involves a targeted assessment rather than a comprehensive evaluation.
This code is often overlooked because it shares the same fee as the repeat consultation code (A186), leading to confusion over when to appropriately use W385. Opt for W385 when the issue is a new, focused question rather than revisiting a previously consulted problem.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A180 | Special neurology consultation | As needed | Comprehensive neurologic evaluations or complex cases. |
| A185 | Consultation | As needed | Standard neurological consultations. |
| A186 | Repeat consultation | As needed | Follow-up consultations for previously addressed issues. |
| A385 | Limited consultation | As needed | Equivalent service under different OHIP system parameters. |
3Eligibility Requirements
To be eligible for billing under the W385 code, the consultation must occur at least six months after a periodic health visit, as stipulated by the Nursing Homes Act. Additionally, this code adheres to standard consultation frequency limits, allowing for one service per two consecutive 12-month periods for the same patient, physician, and diagnosis, or one service every 12 months for an unrelated diagnosis. Documentation must clearly support the focus of the consultation as a distinct and new query pertaining to the patient's neurological care.
4What Your Clinical Note Must Show
Ensure documentation clearly indicates the focused, limited nature of the consultation and complies with OHIP and Nursing Homes Act provisions.
- Mention the specific neurological question addressed.
- Include the outcome of the consultation.
- Note any follow-up recommendations or actions taken.
5Weak vs. Strong Note Examples
The strong note succeeds due to its explicit focus and detailed outcome, while the weak note lacks specificity and fails to document consultation results.
Patient seen for tremor evaluation. Consulted on possible causes. No further details documented.
Patient presented with tremor following medication change.
Neurological examination limited to assessing tremor origin. Consultation focused on whether medication is causative.
Decision: Adjusted medication; instructed staff to monitor. Recommendations to follow up in one month if symptoms persist.
- Focused question addressed.
- Actionable conclusion and recommendations.
