1What Is the W446 OHIP Code?
The W446 billing code refers to a repeat consultation within medical oncology, specifically for patients who have been previously assessed. These consultations are typically requested for long-term care in-patients such as nursing home residents, where there is a change in the malignancy or a shift in management focus. A new written request from the referring physician, nurse practitioner, or dental surgeon is mandatory for billing this code.
W446 is commonly missed because routine attendances in a long-term care setting often fall under the W-series subsequent visit codes. Without a new written request, the service will be adjusted to a general or specific assessment.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A445 | Consultation | One-time consultation | Standard consultation for new oncology patients. |
| A446 | Repeat consultation | As needed with new request | External repeat consultation for oncology patients. |
| A845 | Limited consultation | As needed with limitations | Consultation with limited scope for oncology patients. |
| C445 | Consultation | One-time consultation | Consultation outside of medical oncology specialty. |
3Eligibility Requirements
To be eligible for W446, certain criteria must be met:
- A new written request must be submitted by the referring physician, nurse practitioner, or dental surgeon.
- The service must follow at least six months after a Periodic health visit as per the Nursing Homes Act.
- This code is specifically for repeat consultations and is exempt from consultation frequency limits outlined in GP17.
- Failure to meet these conditions may result in adjustments to a general or specific assessment payment.
4What Your Clinical Note Must Show
For a repeat consultation claim, ensure you have:
- A new written request from the referring physician, nurse practitioner, or dental surgeon.
- Complete documentation of the initial consultation.
- Updated clinical notes documenting the reason for the repeat consultation.
5Weak vs. Strong Note Examples
The strong note clearly documents the progression in the patient's condition and outlines the responsive changes made to the treatment plan, ensuring that the consultation is substantiated as a repeat rather than a routine follow-up.
Patient seen for follow-up. No new issues noted. Same management plan continued.
Re-evaluated patient due to progression of malignancy. New written request received from Dr. Smith. Adjusted treatment plan after comprehensive assessment.
- Discussed shift from aggressive treatment to palliative care.
- Reviewed lab results and imaging studies.
- Coordinated with multidisciplinary team for holistic management.
