1What Is the W795 OHIP Code?
The W795 billing code in OHIP is utilized for geriatric psychiatric consultations, often conducted in settings such as long-term care facilities. These consultations are pivotal for addressing complex psychiatric conditions in the elderly, including behavioral and psychological symptoms of dementia, determining underlying causes of mood changes, and assessing medication burdens. This comprehensive consultation requires a minimum of 75 minutes of direct patient interaction to provide thorough evaluation and care planning.
Physicians should note that geriatric psychiatric consultations are frequently missed in documentation where there is confusion about billing in different settings or when a less complex consultation might mistakenly be used. Accurately recognizing when a higher level consult is needed can ensure appropriate coding and reimbursement for these complex assessments.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A795 | Geriatric psychiatric consultation | Same conditions as W795 | Similar service as W795 for different settings or documentation variations. |
| A190 | Special psychiatric consultation | As applicable in listed sections | Consultation involving a minimum of 75 minutes direct contact. |
| A195 | Consultation | As needed | Regular consultation billed at a lower rate than W795. |
| A196 | Repeat consultation | As needed | Follow-up consultations at a lesser fee. |
3Eligibility Requirements
Eligible physicians, particularly those specializing in psychiatry, can bill OHIP for W795 when conducting a geriatric psychiatric consultation. This can be dispensed virtually through video consultations, reflected as W795A, but not through telephone interactions.
A physician may bill one service per two consecutive 12-month periods for the same patient, diagnosis, and provider. An exception allows for a second service within that timeframe if it is over 12 months since the first consultation and the patient is in a hospital or emergency department. For different diagnoses, physicians may provide this service once every 12 months. If frequency limits are exceeded, payment defaults to general or specific assessment rates.
4What Your Clinical Note Must Show
Accurate, detailed records are essential for billing the W795 code. Physicians must document:
- Patient's clinical history and current psychiatric symptoms
- Comprehensive mental status examination
- Diagnosis and identification of complex psychiatric issues
- Duration of patient interaction ensuring a minimum of 75 minutes direct contact
- Rationale for treatment plan or alterations, including medication management if applicable
5Weak vs. Strong Note Examples
The strong note provides a detailed account of the psychiatric consultation, duration, and clinical reasoning necessary for billing the W795 code. The weak note lacks comprehensive detail and does not meet the time requirement.
Patient presents with depressive symptoms. Consultation lasted 45 minutes. Treatment plan established.
Conducted a detailed geriatric psychiatric consultation with patient presenting complex late-life depression and dementia symptoms.
Direct interaction with the patient lasted 80 minutes, involving comprehensive mental status exam, differential diagnosis of psychiatric symptoms, and intricate treatment strategy.
- Reviewed recent behavioral changes which may indicate an untreated medical condition.
- Analyzed medication regimen to tailor an appropriate tapering plan for antipsychotics.
