1What Is the W645 OHIP Code?
The W645 OHIP billing code is designated for consultations in General Thoracic Surgery, specifically for residents of chronic care hospitals, nursing homes, or homes for the aged. It is commonly used when assessing long-stay residents with symptomatic thoracic problems to determine their potential candidacy for surgery.
This consultation is particularly relevant in situations where the patient's frailty and comorbidities require a thorough evaluation by a thoracic surgeon. Many physicians miss billing this code because they may not differentiate between a consultation and a typical assessment, especially in long-term care settings.
To capture this billing opportunity, ensure that a formal consultation request is documented, and a detailed written report is provided back to the referring physician.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | Variable | Higher complexity consultations in General Thoracic Surgery. |
| C935 | Special surgical consultation | Variable | Higher complexity consultations in General Thoracic Surgery. |
| A645 | Consultation | Variable | General Thoracic Surgery consultations similar to W645. |
| A646 | Repeat consultation | Variable | Repeat consultations at a reduced rate. |
3Eligibility Requirements
Eligibility Requirements for W645
W645 can be billed for consultations related to non-emergency long-term care in-patient services. Eligible settings include:
- Chronic Care Hospitals
- Convalescent Hospitals
- Nursing Homes
- Homes for the Aged
Note: This does not include patients in designated palliative care beds or emergency care. Eligibility extends to reassessments in the case of a new, unrelated diagnosis every 12 months or when a second consultation is required under specific inpatient conditions beyond 12 months after the first consultation.
To qualify:
- A written request from a referring physician, nurse practitioner, or dental surgeon is necessary.
- The consultant must prepare a thorough written report including findings, opinions, and recommendations.
Failure to meet these criteria results in payment at a more reduced assessment rate.
4What Your Clinical Note Must Show
The following documentation must be maintained to support W645 billing eligibility.
- A copy of the referral request signed by the referring professional.
- Identification of the consultant and the referring professional by name and billing number.
- Patient identification, including name and health number.
- Documentation of the information relevant to the referral, specifying required services.
- A written report of the consultation including findings, opinions, and recommendations.
Precise time documentation is required for service payment.
- Start and end times of the consultation must be recorded in the patient’s permanent medical record.
5Weak vs. Strong Note Examples
The strong note provides a detailed account of the consultation with specific times, a narrative of actions taken, and references the received and addressed consultation request, ensuring compliance with billing requirements.
Consultation occurred. Assessed patient's thoracic issue. Will report back.
Performed detailed consultation for Mr. Smith at XYZ Nursing Home.
Evaluated the patient's thoracic pain and possible surgical interventions, considering comorbidities.
- Written consultation request from Dr. Johnson reviewed.
- Consultation occurred from 10:30 AM to 11:10 AM.
- Report prepared and sent to Dr. Johnson with findings and recommendations.
