A120

PDF page 232 / A104

GENERAL LISTINGS
A415 Consultation............................................................................              159.45
A545 Limited consultation ................................................................                 106.90
A416 Repeat consultation ................................................................                  106.90
A413 Medical specific assessment ..................................................                         95.95
A414 Medical specific re-assessment..............................................                           72.00
A411 Complex medical specific re-assessment...............................                                  83.40
A418 Partial assessment .................................................................                   44.75
A120 Colonoscopy assessment, same day as colonoscopy ...........                    18.85
    Note:
    1.A120 is the only assessment service eligible for payment on the same day as a colonoscopy
      if a major pre-operative visit has been rendered by any physician in the 12 month period prior
      to the date of the colonoscopy service.
      2.A120 is not eligible for payment if a major pre-operative visit is eligible for payment on the
        same day as colonoscopy.
      3.A120 is only eligible for payment to physicians in the following specialties:
        Internal Medicine (13) and Gastroenterology (41).
      [Commentary:
      For the definition of major pre-operative visit, see the definition page GP4.]

PDF page 257 / A129

CONSULTATIONS AND VISITS
      INTERNAL MEDICINE (13)
                 GENERAL LISTINGS
               A135 Consultation............................................................................               192.85
                 Comprehensive internal medicine consultation
                   This service is a consultation rendered by a specialist in internal medicine who provides all the
                   appropriate 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 patient.
               A130 Comprehensive internal medicine consultation ......................           342.25
                   Medical record requirements:
                   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 fee.
                                          [Commentary:
                                          1.A130 must satisfy all the elements of a consultation (see page GP16).
                                          2.Unless otherwise specified in the Schedule, the calculation time for comprehensive internal
                                            medicine consultations excludes (1) time devoted to any other service or procedure for which
                                            an amount is payable in addition to the consultation and (2) non-patient-facing time such as
                                            such as time spent reviewing charts, imaging, or documentation, etc.]
               A435 Limited consultation ................................................................                  123.10
               A136 Repeat consultation ................................................................                   123.10
               A133 Medical specific assessment ..................................................                          95.95
               A134 Medical specific re-assessment..............................................                            72.00
               A131 Complex medical specific re-assessment...............................                                   83.40
               A138 Partial assessment .................................................................                    44.75
               A120 Colonoscopy assessment, same day as colonoscopy ...........                        18.85
                   Note:
                   1.A120 is the only assessment service eligible for payment on the same day as a colonoscopy
                     if a major pre-operative visit has been rendered by any physician in the 12 month period prior
                     to the date of the colonoscopy service.
                   2.A120 is not eligible for payment if a major pre-operative visit is eligible for payment on the
                     same day as colonoscopy.
                   3.A120 is only eligible for payment to physicians in the following specialties: Internal Medicine
                     (13) and Gastroenterology (41).
                                          [Commentary:
                                          For the definition of major pre-operative visit, see the definition page GP4.]
               K045 Diabetes management by a specialist ....................................     80.25
               K046 Diabetes team management................................................... 127.20
                   [Commentary:
                   For K045 and K046 definition/required elements, payment rules and record keeping
                   requirements see Endocrinology and Metabolism section.]

PDF page 701 / S19

DIGESTIVE SYSTEM SURGICAL PROCEDURES
 INTESTINES (EXCEPT RECTUM)
                                                                              Asst     Surg     Anae
              b.multiple random screening biopsies (>34 sites) for malignant changes in inflammatory
                bowel disease, or targeted biopsies have been collected using 1) Dye-chromoendoscopy
                (DCE), 2) virtual chromoendoscopy (VCE) with narrow band imaging (NBI), or 3) high-
                definition white-light-endoscopy (HD-WLE) with HD-iScan, or equivalent.
         [Commentary:
         1.E749 is not eligible for payment in a hospital or ICHSC.
         2.For assessments claimed same day as colonoscopy by Internal Medicine (13) or
           Gastroenterology (41) see A120.
         3.E785 is not eligible for payment in the context of standard definition white light endoscopy
           (SD-WLE).]
# Z513 Hydrostatic - Pneumatic dilatation of colon stricture(s) through
         colonoscope .......................................................................              107.50
# Z571 Excision of first polyp (3 mm to 5mm).....................................                   nil   150.15   4
# E720   - each additional polyp (3 mm to 5 mm)....................... add                                 77.50
# Z518 Excision of first polyp (6 mm to 9 mm)....................................                   nil   150.15   4
# E520   - each additional polyp (6 mm to 9 mm)...................... add                                  77.50
# Z517 Excision of first polyp (10 mm to 19 mm)................................                     nil   150.15   4
# E519   - each additional polyp (10 mm to 19 mm ................... add                                   77.50
# Z516 Excision of first polyp (20 mm to 29 mm)................................ nil 150.15                         4
# E518    - each additional polyp (20 mm to 29 mm).................. add             77.50
      Payment rules:
      1.Only one of Z571, Z518, Z517 or Z516 is eligible for payment per patient per day.
         2.A maximum of 2 services of any combination of E720, E520, E519, or E518 are eligible for
            payment per patient per day.
         3.Excision of polyps <3mm is not eligible for payment.
         Claims submission instructions:
         The largest polyp excised should be used to determine the appropriate fee code to claim for the
         first polyp (Z571, Z518, Z517 or Z516).
      Note:
      Z497, Z499, Z492, Z493, Z496, Z494, Z498, Z495, Z491, and Z555 include fulguration, if
      performed.
# E685 Total excision of very large sessile polyp (> 3 cm) through
           colonoscope, and may include fulguration, each ...............      227.65
      Excision of obstructive tumour or stricture through colonoscopy
# Z764 - less than 2 cm. ...................................................................               69.80
# Z765 - 2 cm or greater ...................................................................              131.75
# E687    - with laser debulking ................................................... add                   69.80

Master, record 68. Record Layout PDF, page 1.

A12020250601999999990000000000000000000000000001885000000000000000000000000

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.