1What Is the W695 OHIP Code?
What is the W695 Code?
The W695 code is designated for neurodevelopmental consultations provided by psychiatrists in Ontario. This service involves a comprehensive assessment of patients with complex neurodevelopmental conditions, such as intellectual disabilities or autism, particularly when there are significant behavioral changes.
The consultation helps determine whether these changes are due to psychiatric conditions, environmental triggers, or are natural progressions of the neurodevelopmental disorder. This structured evaluation is especially crucial for long-term care in-patients who might not have had access to such assessments before. It is important to note that coding errors such as billing with the wrong service location prefix (e.g., using the hospital prefix instead of one for long-term care) are common.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A190 | Special psychiatric consultation | As per A195 conditions | Used for special psychiatric consultations where a physician spends 75 minutes in direct patient contact. |
| A195 | Consultation | As per general conditions | A standard psychiatric consultation. |
| A196 | Repeat consultation | As per repeat conditions | Billed for repeat psychiatric consultations. |
| A395 | Limited consultation | As per limited conditions | Used for limited psychiatric consultations. |
3Eligibility Requirements
Eligibility Requirements for W695
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Billing Frequency: W695 can be billed once every two consecutive 12-month periods for the same patient, physician, and diagnosis. A second service within this period is allowed when provided to an inpatient or Emergency Department patient after more than 12 but less than 24 months. For unrelated diagnoses, one service is billable every 12 months.
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Service Settings: Neurodevelopmental consultations for children or adolescents, or for less complex conditions like ADHD, should be billed at lower rates under different codes.
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Claim Submission Instructions: Submit claims using the appropriate setting-specific prefix; begin with 'C' for hospital inpatient, 'W' for long-term care inpatient, or 'K' for an Emergency Department patient.
4What Your Clinical Note Must Show
Proper documentation is key for successful billing of W695.
- Detailed patient history and presenting problem.
- Comprehensive assessment findings.
- Rationale for diagnosis and treatment plan.
- Explanation of any related procedures that might affect billing.
- Documentation of time spent directly with the patient.
5Weak vs. Strong Note Examples
The strong note succeeds because it provides detailed assessment findings, a structured management plan, and justifies the code selection with clear documentation of time spent, whereas the weak note lacks specificity and thoroughness.
Patient seen for behavioral changes in long-term care. Discussed possible causes.
Comprehensive neurodevelopmental consultation conducted for patient with intellectual disability showing significant behavioral changes. Assessed environmental triggers and psychiatric conditions. Formulated a structured management plan.
Reviewed past medical records and interviewed facility staff for complete background. Time spent: 90 minutes.
- Clear documentation of patient history.
- In-depth discussion of assessment findings.
- Justification for the specific consultation code billed.
