W395 OHIP Billing Code: Streamlined Psychiatric Consultations

The W395 OHIP billing code is designed for limited psychiatric consultations, primarily intended for long-term care in-patients. This code applies when a psychiatrist is tasked with addressing a single, focused psychiatric question, such as determining the cause of new agitation or assessing a resident's capacity for a specific decision. Discussions typically occur on-site, without a full assessment, fulfilling a specific clinical need efficiently.

It's common for physicians to miss using this code appropriately due to its similarity in fee to the A196 repeat consultation code. The main distinguishing factor for W395 is whether it's addressing a brand-new question, unlike a re-evaluation of a previously consulted issue.

W395 is eligible to be billed under the OHIP system only when the consultation is performed via video, as outlined in Appendix J of the eligible comprehensive virtual care services. Telephone consultations do not qualify for billing under this code. Frequency limitations apply, allowing one service per two consecutive 12-month periods for the same patient, physician, and diagnosis. An unrelated diagnosis allows for one service every 12 months.