1What Is the W925 OHIP Code?
The W925 code is used by occupational medicine physicians to bill for limited consultations in non-emergency, long-term care settings for CAD 123.10. These consultations typically address specific issues, such as a focused question about workplace exposure or the completion of an outstanding compensation report. Due to its limited scope, this billing code is often missed when the consultation is mistakenly assumed to require a more comprehensive assessment. Physicians should ensure the consultation does not exceed the service restrictions outlined in the Schedule of Benefits.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A720 | Comprehensive occupational medicine consultation | As per Schedule of Benefits | Extensive assessment typically involving a thorough investigation and management plan. |
| A725 | Consultation | As per Schedule of Benefits | Standard consultation for occupational medical issues, broader than limited. |
| A726 | Repeat consultation | Subject to repeat consultation limits | Follow-up consultation after initial assessment. |
| A925 | Limited consultation | Subject to same consultation frequency limits | Same service as W925 within the Schedule of Benefits. |
3Eligibility Requirements
W925 is applicable in non-emergency long-term care settings, such as chronic care hospitals, nursing homes, homes for the aged, and designated convalescent care beds. The service may also be delivered virtually via video. A valid consultation requires a written request from a referring physician, nurse practitioner, or dental surgeon regarding complex or obscure cases. Frequency limits mandate one service per two consecutive 12-month periods for the same patient and diagnosis, with exceptions for unrelated diagnoses.
4What Your Clinical Note Must Show
A written request is necessary from an eligible referring provider.
- Physician
- Nurse practitioner
- Dental surgeon in relation to a hospital-insured procedure
5Weak vs. Strong Note Examples
The strong note clarifies the specific occupational health issue and includes details from the referral, illustrating the assessment's focus and necessary follow-up, unlike the weak note.
Patient seen for occupational health issue.
No documentation of the specific question or diagnosis addressed.
Focused consultation on occupational exposure to asbestos.
Referral request from Dr. Smith specifying concern over advancing pulmonary symptoms.
- Reviewed past exposure history and current symptoms.
- Provided recommendations for additional testing and monitoring.
