FAMILY PRACTICE & PRACTICE IN GENERAL (00)

1 CONSULTATIONS AND VISITSA pril 1, 2015A1 Amd 12 Draft 1 Consultations and VisitsApril 1, 2015 FAMILY PRACTICE & PRACTICE IN GENERAL (00) GENERAL FAMILY and GENERAL PRACTICE consultation This service is a consultation rendered by a GP/FP physician who provides all the elements of a consultation and spends a minimum of fifty (50) minutes of direct contact with the patient exclusive of time spent rendering any other separately billable intervention to the FAMILY and GENERAL PRACTICE consultation .. FAMILY and GENERAL PRACTICE consultationThis service is a consultation rendered by a GP/FP physician who provides all the elements of a consultation and spends a minimum of seventy-five (75) minutes of direct contact with the patient exclusive of time spent rendering any other separately billable intervention to the FAMILY and GENERAL PRACTICE consultation.

2 A911 and A912, the start and stop times must be recorded in the patient s permanent medical record or the amount payable for the service will be adjusted to a lesser paying other consultation, assessment, visit or counselling service is eligible for payment when rendered the same day as one of A911 or A912 to the same patient by the same physician.[ and A912 must satisfy all the elements of a consultation (see page GP12). calculation of the 50 minute and 75 minute minimum for special and comprehensive consultations respectively excludes time devoted to any other service or procedure for which an amount is payable in addition to the consultation.]

3 ]Special palliative care consultationA special palliative care consultation is a consultation requested because of the need for specialized management for palliative care where the physician spends a minimum of 50 minutes with the patient and/or patient's representative/ FAMILY in consultation (majority of time must be spent in consultation with the patient). In addition to the GENERAL requirements for a consultation, the service includes a psychosocial assessment, comprehensive review of pharmacotherapy, appropriate counselling and consideration of appropriate community services , where palliative care consultation.

4 And stop times must be recorded in the patient s permanent medical record or the amount payable for the service will be adjusted to a lesser paying fee. the duration of a palliative care consultation (A945 or C945) exceeds 50 minutes, one or more units of K023 are payable in addition to A945 or C945, provided that the minimum time requirements for K023 are met. The time periods for A945 or C945 and K023 are mutually exclusive ( the start time for determination of minimum time requirements for K023 occurs 50 minutes after start time for A945 or C945).A905 Limited consultation .. consultation.

5 AND VISITSA2 April 1, 2015 Amd 12 Draft 1 April 1, 2015 FAMILY PRACTICE & PRACTICE IN GENERAL (00)A003 GENERAL :A003 is not eligible for payment for an assessment provided in the patient s home.[Commentary:Electrocardiography ( G310, G313) and pulmonary function test services ( J301, J304, J324, J327) are not payable when rendered to a patient who does not have symptoms, signs or an indication supported by current clinical PRACTICE guidelines relevant to the individual patient s circumstances.]A004 GENERAL re-assessment .. :The papanicolaou smear is included in the consultation, repeat consultation, GENERAL or specific assessment (or re-assessment), or routine post natal visit when pelvic examination is normal part of the foregoing services .

6 However, the add-on codes E430 or E431 can be billed in addition to these services when a papanicolaou smear is performed outside department equivalent - partial assessmentAn emergency department equivalent - partial assessment is an assessment rendered in an emergency department equivalent on a Saturday, Sunday or Holiday for the purpose of dealing with an department equivalent - partial assessment .. [Commentary:For services described by emergency department equivalent - partial assessment, the only fee code payable is A888.]Payment or counselling rendered to the same patient by the same physician on the same day as A888 are not eligible for premiums are payable for a service rendered in an emergency department equivalent.

7 CONSULTATIONS AND VISITSA pril 1, 2015A3 Amd 12 Draft 1 April 1, 2015 FAMILY PRACTICE & PRACTICE IN GENERAL (00)House call assessmentA house call assessment is a primary care service rendered in a patient s home that satisfies, at a minimum, all of the requirements of an intermediate assessment. A901 House call assessment .. rules:A house call assessment is only eligible for payment for the first person seen during a single visit to the same location. [Commentary: services rendered to additional patients seen during the same visit are payable at a lesser fee from the GENERAL Listings.] Complex house call assessmentA complex house call assessment is a primary care service rendered in a patient's home to a patient that is considered either a frail elderly patient or a housebound patient.

8 The service provided must satisfy, at a minimum, all of the requirements of an intermediate assessment. A900 Complex house call assessment .. rules:A complex house call assessment is only eligible for payment for the first person seen during a single visit to the same location. [ frail elderly patient is defined years or older with one or more of the following age-related illness(es), condition(s) or presentation(s) medical management needs; ; impairment ( dementia or delirium); reduced mobility or falls; functional decline not otherwise in a home that patient's home; living or retirement residence (but does not include a long-term care home).]

9 Housebound patient is defined person will be considered homebound where all the following criteria are person has difficulty in accessing office-based primary health care services because of medical, physical, cognitive, or psychosocial needs/conditions; and other strategies to remedy the access difficulties have been considered but are not available or not appropriate in the person's circumstances; person's care and support requirements can be effectively and appropriately delivered at home.]Medical record requirements:Complex house call assessment is not payable If the medical record does not: that an intermediate assessment was rendered; and that the patient was a frail elderly or housebound call assessment - Pronouncement of death in the homeA house call assessment - Pronouncement of death in the home is the service rendered when a physician pronounces a patient dead in a home.

10 This service includes completion of the death certificate and counselling of any relatives which may be rendered during the same call assessment - Pronouncement of death in the submission instructions:Submit the claim using the diagnostic code for the underlying cause of death as recorded on the death certificate. Note:For special visit premiums, please see pages GP44 to GP52 of the GENERAL AND VISITSA4 April 1, 2015 Amd 12 Draft 1 April 1, 2015 FAMILY PRACTICE & PRACTICE IN GENERAL (00)Pre-dental/Pre-operative assessmentsPre-dental/Pre-operative Assessments are services required to provide history and physical exam information to the peri-operative team that will be assessing suitability for surgery and anaesthesia.