A264

PDF page 42 / GP28

FIRST VISIT BY PRIMARY CARE PHYSICIAN AFTER HOSPITAL DISCHARGE
  E080 First visit after hospital discharge premium, to other service
          listed in payment rule 5 below ..................................... add        25.90
      Payment rules:
      1.Subject to payment rules 2 through 5, E080 is only eligible for payment for a visit with the
        patient's primary care physician in the physician’s office or the patient’s home within two
        weeks of discharge following in-patient admission to an acute care hospital.
      [Commentary:
      This premium is not payable for visits rendered to patients in locations other than the
      physician's office or patient's home. As such, the premium is not payable for services rendered
      in places such as Nursing Homes, Homes for the Aged, chronic care hospitals, etc.]
      2.E080 is not eligible for payment if the admission to hospital was for the purpose of obstetrical
        delivery unless the mother required admission to an ICU during the hospital stay.
      3.E080 is not eligible for payment if the admission to hospital was for the purpose of newborn
        care unless the infant required admission to a NICU during the hospital stay.
      4.E080 is not eligible for payment if the admission to hospital was for the purpose of performing
        day surgery.
      5.E080 is only eligible for payment when rendered with the following services:
        A001, A003, A004, A007, A008, A261, A262, A263, A264, A888, A900, K004–K008, K013,
        K014, K022, K023, K028-K030, K032, K033, K037, K623, P003, P004, P008.

PDF page 298 / A170

CONSULTATIONS AND VISITS
      PAEDIATRICS (26)
                                  Prenatal consultation
                                   A prenatal consultation is the service rendered by a paediatrician upon request of a physician
                                   or nurse practitioner who considers a fetus of greater than 20 weeks gestation to be at risk or in
                                   jeopardy by reason of continuation of pregnancy in the presence of maternal and/or fetal
                                   distress.
                   [Commentary:
                   A prenatal consultation by a paediatrician does not preclude the paediatrician from claiming a
                   post-natal consultation on the infant.]
               A665 Prenatal consultation ..............................................................  105.50
               A565 Limited consultation ................................................................ 104.70
               A266 Repeat consultation ................................................................  104.70
               A263 Medical specific assessment ..................................................                                     95.75
               A264 Medical specific re-assessment..............................................                                       70.75
               A661 Complex medical specific re-assessment...............................                                              86.35
               A268 Enhanced 18 month well baby visit (see General Preamble
                      GP34) .................................................................................                          74.25
               A261 Level 1 - Paediatric assessment.............................................                                       24.85
               A262 Level 2 - Paediatric assessment.............................................                                       50.20
               E078                           - chronic disease assessment premium (see General
                                                Preamble GP25) ................................................ add 50%
               K045 Diabetes management by a specialist ....................................   80.25
                   [Commentary:
                   For K045 definition/required elements, payment rules, and record keeping requirements, see
                   Endocrinology and Metabolism section.]
                 Periodic health visit
               K267 - 2 - 11 years of age.............................................................. 48.05
               K269 - 12 - 17 years of age ...........................................................  89.15
                   Note:
                   1.For definitions and payment rules - see General Preamble GP21.
                   2.Diagnostic interview and/or counselling with child and/or parent - see listings in Family
                     Practice & Practice in General.
                 Paediatric Developmental Assessment Incentive (PDAI)
                   PDAI is the service rendered by a paediatrician most responsible for providing ongoing
                   management of a paediatric patient at developmental risk. The service is for ongoing
                   management using a developmental surveillance approach and documenting the indicators of
                   the child’s development three times in a 12 month period.
               K119 Paediatric developmental assessment incentive ....................          142.50
                   Payment rules:
                   1.K119 is limited to a maximum of one service per patient per 12 month period.
                                          2.K119 is limited to a maximum of six services per patient per lifetime.
                                          3.K119 is only eligible for payment for a service rendered to a person under six years of age.

Master, record 149. Record Layout PDF, page 1.

A26420260401999999990000000000000000000000000007075000000000000000000000000

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.