1What Is the W845 OHIP Code?
W845 is an OHIP billing code used by oncologists for limited consultations in long-term care facilities. This service typically addresses a specific, focused oncology-related question about a resident, such as assessing new symptoms for disease progression or evaluating the usefulness of continued surveillance scans due to the patient's frailty. Unlike more comprehensive consults, the limited consultation involves a singular, pointed inquiry.
Due to its specialized nature, this code is often missed when the scenario is mistaken for a repeat consultation of an existing issue that has already been addressed. It is vital to distinguish new or distinct clinical questions from those previously reviewed and documented.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A445 | Consultation | As needed | In-depth consultation for complex oncological diagnoses. |
| A446 | Repeat Consultation | As necessary following initial consultation | Follow-up consultations for re-assessing unresolved issues. |
| A845 | Limited Consultation | Once per two consecutive 12-month periods | Same service as W845 but outside of long-term care setting. |
| C445 | Consultation | As needed | Standard consultation, typically for first-time evaluations. |
3Eligibility Requirements
Under OHIP regulations, the W845 Limited Consultation can only be billed in certain circumstances. It is available to oncology specialists conducting limited, focused consultations for long-term care in-patients. It may be billed once per two consecutive 12-month periods for the same patient, physician, and diagnosis, and once every 12 months for an unrelated diagnosis.
Note: This code can only be claimed 6 months after a patient has undergone a Periodic Health Visit as per the Nursing Homes Act. Ensure all criteria are met prior to billing this service.
4What Your Clinical Note Must Show
Ensure eligibility criteria are fully met before billing.
- Confirm patient's last Periodic Health Visit was over 6 months ago.
- Verify the consultation is occurring in a long-term care setting.
Document detailed clinical notes for each limited consultation.
- State the specific oncological issue addressed.
- Summarize findings and clinical decisions made.
Adhere to frequency limits for consultations.
- Verify that no other W845 has been billed for this patient in the past 24 months.
- Ensure any previously billed consultation was for unrelated diagnosis.
5Weak vs. Strong Note Examples
The strong note clearly outlines the clinical rationale and actions taken, whereas the weak note lacks specificity and comprehensive documentation.
Discussed symptom management with patient, frail.
Evaluated new onset shortness of breath to determine potential disease progression.
Determined no current evidence to suggest significant progression as per recent scan.
Recommendation: Continue current surveillance schedule.
- Documented presentation details
- Described clinical decision-making process
- Outlined follow-up recommendations
