W662 OHIP Billing Code: Extended Paediatric Consultation

1What Is the W662 OHIP Code?

What is the W662 OHIP Billing Code?

The W662 code refers to an Extended Special Paediatric Consultation, applicable in Ontario, CA. It is designed for comprehensive consultations with paediatric patients in long-term care settings. This typically involves complex assessments or care plan revisions due to conditions like recurrent aspiration, escalating seizures, or the need for advanced respiratory support.

This code is often overlooked due to its specific application within long-term care settings. It should not be confused with consultations for hospital in-patients or those conducted in office or clinic environments.

2Related Codes

Code	Name	Frequency	Description
A260	Special Paediatric Consultation	One per patient per 12 months	Applicable for paediatric consultations addressing specific issues in an office or clinic.
A265	Consultation	One per patient per 12 months	Standard consultation for paediatric patients in various settings.
A266	Repeat Consultation	One per patient every 6 months	For follow-up consultations post initial consultation.
A565	Limited Consultation	Not restricted	For less extensive consultations with paediatric patients.

3Eligibility Requirements

Eligibility for W662

The W662 billing code is applicable for paediatric consultations in long-term care settings, limited to one per physician per patient per 12 months. An exception allows for two services in a two-year period if the second is provided in a hospital or Emergency Department.

This code must not be billed if any other service is rendered concurrently, unless a specific medical assessment (C263) accompanies a maternal delivery for a sick newborn. Start and stop times must be documented in the patient's medical record, or a reduced fee will be applied.

4What Your Clinical Note Must Show

1Documentation Requirements for W662

Adherence to documentation standards is crucial for billing W662 successfully.

Record the start and stop time of the consultation in the patient's permanent medical record.
Ensure that all medical decision-making and care plan adjustments are thoroughly documented.

5Weak vs. Strong Note Examples

The strong note succeeds because it details the consultation length, specific actions taken, and collaborative decision-making, whereas the weak note provides insufficient information.

❌ Weak Note

Conducted consultation; discussed patient's condition with the team.

✓ Strong Note

Conducted a 60-minute consultation to assess the escalation in seizure activity. Reviewed recent tests and adjusted the care plan in coordination with the neurology and respiratory teams. Documented goals of care, family's concerns, and agreed on palliative approach if necessary.

Start time: 10:00 AM
End time: 11:00 AM

6Common Reasons This Code Is Missed

Confusion with Other Codes

W662 is often mistaken for codes used in different settings, such as C662 or A662.

Documentation Incomplete

Failure to log start and stop times results in reduced reimbursement.

Concurrency with Other Services

Billing this code alongside other services might lead to denial if not clearly eligible, particularly without a C263 assessment.

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8Frequently Asked Questions

What is the billing fee for W662?

The flat fee for W662 is CAD 442.40.

How frequently can W662 be billed for the same patient?

It may be billed once per patient, per 12-month period, with certain exceptions for hospital in-patients.

What type of patient conditions justify the use of W662?

Conditions such as recurrent aspiration, severe seizures, or advanced respiratory issues in long-term care qualify for W662.

How does the W662 differ from a regular paediatric consultation?

W662 allows for in-depth reviews of complex or evolving care needs in long-term care settings, unlike standard consultations.

Is a referral required for billing W662?

Yes, typically a referral from another healthcare provider is necessary, especially for complex conditions.

Why might a consultation in a long-term care setting qualify for W662?

The extended complexity of care and coordination with multiple specialties for chronic conditions qualifies this consultation for W662.

What should be done if services are rendered concurrently?

Ensure eligibility by documenting a C263 assessment if applicable, otherwise avoid billing other services concurrently.

What if a referral originated from the Emergency Department?

If the second consultation occurs in a hospital or ED setting within specified time frames, W662 might still apply.

Disclaimer: This article is intended as a general educational resource for physicians and billing staff. It does not constitute billing advice or a definitive interpretation of the OHIP Schedule of Benefits. Always verify current billing codes, eligibility criteria, and documentation requirements directly against the official Schedule of Benefits or consult with a qualified medical billing specialist.

W662 OHIP Billing Code: Extended Special Paediatric Consultation

1What Is the W662 OHIP Code?

What is the W662 OHIP Billing Code?

2Related Codes

3Eligibility Requirements

Eligibility for W662

4What Your Clinical Note Must Show

5Weak vs. Strong Note Examples

6Common Reasons This Code Is Missed

8Frequently Asked Questions