A100

PDF page 124 / GP110

GENERAL PREAMBLE
EMERGENCY DEPARTMENT ALTERNATIVE FUNDING AGREEMENTS
When one or more physicians have contracted with the MOH to provide insured physician services
under an emergency department alternative funding agreement (ED AFA) in lieu of fee-for-service
payments under the Schedule, then no insured service encompassed by the contract relating to the
emergency department alternative funding agreement is payable, whether or not the physician who
renders the service is a party to the contract unless the physician is/are:
     a. a second on-call physician who either does or does not participate in the ED AFA and who
        can submit fee-for-service claims under the hospital’s ED AFA second on-call group number;
     b. general practitioner experts (‘GP Experts’) who, in accordance with the ED AFA, are entitled
        to submit fee-for-service claims under the hospital’s ED AFA GP Expert group number; or
     c. the patient's general/family physician only for services payable as A100 - General/Family
        Physician Emergency Department Assessment.

PDF page 135 / A7

CONSULTATIONS AND VISITS
 FAMILY PRACTICE & PRACTICE IN GENERAL (00)
        On-call admission assessment
          On-call admission assessment is the first hospital in-patient admission general assessment per
          patient per 30-day period if:
         a. the physician is a general practitioner or family physician participating in the hospital’s on-
            call roster whether or not the physician is on-call the day the service is rendered;
         b. the admission is non-elective; and
      c. the physician is the most responsible physician with respect to subsequent in-patient care.
       The amount payable for any additional on-call admission assessment rendered by the same
       physician to the same patient in the same 30-day period is reduced to the amount payable for a
       general re-assessment.
   A933 On-call admission assessment ...............................................  82.00
     General/Family physician emergency department assessment
       General/Family physician emergency department assessment is an assessment of a patient
       that satisfies as a minimum the requirements of an intermediate assessment and is rendered
       by the patient's general/family physician in an emergency department funded under an
       Emergency Department Alternative Funding Agreement (ED-AFA). For that visit, the service
       includes any re-assessment of the patient by the general/family physician in the emergency
       department and any appropriate collaboration with the emergency department physician.
       The service is only eligible for payment when the general/family physician's attendance is
       required because of the complexity, obscurity or seriousness of the patient's condition.
   A100 General/Family physician emergency department assessment                        78.95
       Payment rules:
       No other service (including special visit or other premiums) rendered by the same physician to
       the same patient during the same visit to the emergency department is eligible for payment with
       this service.
          Claims submission instructions:
          For claims payment purposes, the hospital master number associated with the emergency
          department must be submitted on the claim.
          [Commentary:
          1.Services described as A100 rendered in an emergency department not funded under an ED-
            AFA may be payable under other existing fee schedule codes.
          2.In the event the patient is subsequently admitted to hospital, and the general/family physician
            remains the MRP for the patient, the General/Family Physician emergency department
            assessment constitutes the admission assessment. see General Preamble GP41 for
            additional information.]
     Certification of death
       Certification of death is payable to the physician who personally completes the death certificate
       on a patient who has been pronounced dead by another physician, medical resident or other
       authorized health professional. Claims submitted for this service must include the diagnostic
       code for the underlying cause of death as recorded on the death certificate. The service may
       include any counselling of relatives that is rendered at the same visit. Certification of death
       rendered in conjunction with A902 or A777/C777 is an insured service payable at nil.
   A771 Certification of death............................................................... 24.20

Master, record 57. Record Layout PDF, page 1.

A10020260401999999990000078950000000000000000000000000000000000000000000000

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.