W872

PDF page 65 / GP51

Definition/Required Elements of Service:
  Monthly Management of a Nursing Home or Home for the Aged Patient is the provision by the most
  responsible physician (MRP) of routine medical care, management and supervision of a patient in a
  nursing home or home for the aged for one calendar month. The service requires a minimum of two
  assessments of the patient each month, where these assessments constitute services described as
  "W" prefix assessments.
  The requirements above are subject to the exceptions as described in payment rule #8.
         [Commentary:
         As with all services described as assessments, direct physical encounter with the patient is
         required.]
  In addition to the common elements, this service includes the provision of the following services by
  any physician to the same patient during the month.
  A. Services described by subsequent visits (e.g. W003, W008).
  B. Services described by additional visits due to “intercurrent illness” (W121) except if the conditions
     described in Payment rule #7 are satisfied.
  C. Services described by palliative care subsequent visits (e.g. W872).
  D. Services described by admission assessments (e.g. W102, W104, W107).
  E. Services described by periodic health visit or general re-assessments (e.g. W109, W004).
  F. Services described by visit for pronouncement of death (W777) or certification of death (W771)
     except if the services are performed in conjunction with a special visit.
  G. Service described by anticoagulation supervision (G271).
  H. Completion of home care referral form and home care supervision (K070, K071, K072).
  I. Services described by the following diagnostic and therapeutic procedures – venipuncture (G489),
     injection (G372, G373), immunization (G538, G590, G849), collection of cervical cancer screening
     specimen(s) (G365, G394, E430, E431), intravenous (G379), and laboratory test codes (G001,
     G002, G481, G004, G005, G009, G010, G011, G012, G014).
  J. All medication reviews.
  K. All discussions with the staff of the institution related to the patient’s care.
  L. All telephone calls from the staff of the institution, patient, patient’s relative(s) or patient’s
     representative in respect of the patient between the hours of 0700 hours and 1700 hours Monday
     to Friday (excluding holidays).
  M.Ontario Drug Benefit Limited Use prescriptions/forms or Section 8 Ontario Drug Benefits Act
    requests.

PDF page 147 / A19

Subsequent visits (see General Preamble GP49)
                  Chronic care or convalescent hospital
               W002 - first 4 subsequent visits per patient per month .......per visit                             40.05
               W001 - additional subsequent visits (maximum 4 per patient per
                      month).....................................................................per visit         40.05
               W882 - palliative care (see General Preamble GP50) ........per visit                                40.05
                  Nursing home or home for the aged
               W003 - first 2 subsequent visits per patient per month .......per visit                             40.05
               W008 - additional subsequent visits (maximum 2 per patient per
                       month).....................................................................per visit        40.05
               W872 - palliative care (see General Preamble GP50) ........per visit                                40.05
               W121 Additional visits due to intercurrent illness (see General
                      Preamble GP49) .....................................................per visit                40.05
               W124 Subsequent visit – day of discharge ...........................per visit                       71.80

Master, record 6468. Record Layout PDF, page 1.

W87220260401999999990000040050000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.