1What Is the W667 OHIP Code?
What is the W667 Billing Code?
The W667 OHIP billing code applies to neurodevelopmental consultations provided to pediatric patients under complex care circumstances, often within a long-term care setting. This service typically involves a thorough assessment of the child's developmental level, communication abilities, and aims for therapy and education, particularly when there is a need to resolve discrepancies between stakeholders on what the child can realistically achieve.
These consultations are vital for cases involving severe conditions such as cerebral palsy, acquired brain injuries, or progressive neurometabolic disorders, where detailed assessments guide the therapeutic and educational planning for the patient. Physicians should be aware that the W667 code is for long-term care contexts; for similar consultations in hospital inpatient settings, the relevant code is C667, and for office-based assessments, A667 is applicable.
Due to its specific context, the W667 is often missed or overlooked, especially when documentation does not explicitly differentiate between long-term care and other settings.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A260 | Special paediatric consultation | Subject to eligibility rules in Section Rules - Paediatrics | Consultation for special pediatric cases. |
| A265 | Consultation | As applicable per general OHIP policy | Standard pediatric consultation. |
| A266 | Repeat consultation | As applicable per general OHIP policy | Follow-up pediatric consultation. |
| A565 | Limited consultation | As applicable per general OHIP policy | Brief pediatric evaluation. |
3Eligibility Requirements
Eligibility Requirements for W667
General Payment Rules:
- The neurodevelopmental consultation under W667 is limited to one service per patient, per physician, within a 12-month period unless the patient has a clearly defined unrelated diagnosis, in which case it may be billed once every 12 months.
- Exceptions allow for billing twice within a two-year period if the subsequent service is for a hospital inpatient or emergency department patient, occurring more than 12 months but less than 24 months after the first billed service.
Medical Record Requirements:
- The start and stop time of the consultation must be accurately documented in the patient's permanent medical record. Failure to do so will result in the service being reimbursed at a lesser fee.
Additional Billing Considerations:
- This service cannot be billed alongside other services by the same physician at the time of delivery unless the newborn is sick, where a separate assessment code (C263) may also be claimed.
4What Your Clinical Note Must Show
Proper documentation is mandatory to ensure full payment for W667. Please note the following requirements:
- Record the start and stop time of the consultation.
- Ensure all details are entered in the patient's permanent medical record.
5Weak vs. Strong Note Examples
The strong note includes specific timing, comprehensive context, and detailed planning, demonstrating clear alignment with W667 requirements, whereas the weak note lacks specificity and thoroughness.
Consultation done; details entered in the record. Patient discussed with family.
Conducted neurodevelopmental consultation to evaluate current developmental stage and communication capacity. Extensive review held with facility staff and family to set realistic therapeutic and educational goals for the patient with acquired brain injury.
- Start time: 10:00 AM
- Stop time: 11:30 AM
- Full assessment documented in medical record.
