1What Is the W912 OHIP Code?
This billing code refers to a comprehensive consultation provided by family practice or general practice physicians, specifically for patients in non-emergency long-term care settings. These consultations involve at least 75 minutes of direct patient contact, typically on-site, and are intended for residents with significant changes in condition, behavior, or medication, warranting a thorough review.
Despite its broad applicability, this code is often underutilized due to its specific time requirements and the need for detailed documentation of the consultation process. Understanding the appropriate clinical settings and conditions that necessitate such comprehensive evaluations can help facilitate proper billing.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A912 | Comprehensive family and general practice consultation | Subject to the same conditions as W912 | $247.40. |
| A914 | GP focused practice comprehensive consultation by Video | Subject to similar conditions | $247.40. |
| A005 | Consultation | Standard assessment code | $95.60. |
| A006 | Repeat consultation | Used for repeat consults after initial assessment | $47.10. |
3Eligibility Requirements
To bill under W912, the following eligibility requirements must be met:
- Time Requirement: The GP/FP must spend a minimum of 75 minutes in direct patient contact.
- Consultation Definition: Must fulfill the elements of a consultation following a written request from a referring physician, nurse practitioner, or dental surgeon.
- Available Settings: Consultations should be performed in non-emergency long-term care settings like chronic care hospitals, convalescent homes, nursing homes, or homes for the aged.
- Frequency Limits: Per patient, the same physician can bill this consultation only once per two consecutive 12-month periods for the same diagnosis, but twice if the patient is in a hospital or emergency department with the second consultation more than 12 but less than 24 months after the first.
Additionally, documentation such as start and stop times, and a referral request copy must be maintained.
4What Your Clinical Note Must Show
Ensure the following are recorded meticulously:
- Start and stop times of the consultation in the patient's permanent medical record.
- Written consultation request from a legitimate referrer, kept in the medical record.
- Referral details including names, billing numbers, and health number.
- Proof of the time spent exclusively for the consultation, excluding other services.
5Weak vs. Strong Note Examples
The strong note captures detailed timing, referral identity, and consultation specifics, whereas the weak note lacks comprehensive documentation and specific patient interactions.
Consultation conducted for 75 minutes. Patient condition reviewed.
Patient consultation conducted on 2023-10-15 from 10:00 AM to 11:15 AM as per request from Dr. Smith (Ref ID: 123456).
Detailed review conducted to address patient's increasing medication burden.
Long-term care plan revised and documented.
- Written request from referring physician documented.
- Specific details on patient's condition change and management plan outlined.
