1What Is the W405 OHIP Code?
What is W405?
The W405 OHIP billing code refers to a limited consultation primarily in preventive medicine for residents of non-emergency long-term care settings such as chronic care hospitals or nursing homes. These consultations address specific questions like immunization decisions or isolation needs.
Typically, this service is utilized when a referring physician, nurse practitioner, or dental surgeon inquires about a particular aspect of patient care that doesn’t necessitate a full assessment, making it less time-consuming. Frequent misapplications occur when consultations exceed the specific scope intended for this limited service.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A050 | Special community medicine consultation | N/A | A comprehensive and specialized consultation in community medicine, $176.10. |
| A055 | Consultation | N/A | A standard consultation in community medicine, $152.80. |
| A056 | Repeat consultation | N/A | A follow-up consultation in community medicine, $94.75. |
| A400 | Comprehensive community medicine consultation | N/A | An extensive consultation incorporating all aspects of community medicine, $270.60. |
3Eligibility Requirements
Eligibility Requirements for W405
W405 is applicable for non-emergency long-term care in-patient services, primarily for residents in settings like chronic care hospitals, nursing homes, homes for the aged, and others except palliative care beds. This code requires a referral from a physician, nurse practitioner, or dental surgeon based on their professional knowledge of the patient’s medical complexity.
Frequency Limits:
- Only one service per two consecutive 12-month periods for the same patient, physician, and diagnosis.
- For a different diagnosis, one service every 12 months.
- Exceeding these limits may result in payment reduction.
4What Your Clinical Note Must Show
Record the written referral from a qualified source before the consultation.
- Referring physician, nurse practitioner, or dental surgeon details
- Patient identification information
- Specific question or diagnosis referral concerns the consultation.
Document a concise summary of the consultation, focused on the specific inquiry made by the referring professional.
- Details of the preventive medicine advice provided
- Any follow-up actions or additional preventative care suggested
Include comprehensive patient demographics and the non-emergency long-term care setting.
- Patient's residency and care facility information
- Confirmation the consultation is non-emergency
Ensure adherence to the frequency limitations for consultations to validate billing.
- Check previous consultations for the same patient/diagnosis
- Use when eligible under a different diagnosis
5Weak vs. Strong Note Examples
The strong note succeeds because it provides comprehensive details on the referral, patient context, and specific preventive advice offered, whereas the weak note lacks depth and specificity.
Consulted on immunization. Discussed safety.
Received referral from Dr. Smith for Mrs. Brown, residing at Sunny Acres Nursing Home.
Assessed immunization history to address the specific referral question regarding flu vaccine administration.
- Reviewed patient's medical history in relation to recent outbreaks.
- Provided detailed immunization advice and scheduled follow-up.
