A384

PDF page 270 / A142

CONSULTATIONS AND VISITS
NEUROLOGY (18)
 3. the following neuro-oncology conditions:
     a. primary tumor of the central nervous system;
     b. central nervous system metastasis;
     c. neurological complications of cancer therapy;
     d. paraneoplastic neurological syndromes.
 A113 Complex neurological assessment ......................................... 120.00
     Payment rules:
     1.A complex neurological assessment must include the elements of a medical specific re-
       assessment, or the amount payable will be adjusted to lesser assessment fee.
      2.This service is not eligible for payment to a physician for the initial evaluation of the patient by
        that physician.
      3.Complex neurological assessments are limited to 6 per patient, per physician, per 12 month
        period. Services in excess of this limit will be adjusted to a lesser assessment fee.
      4.This service is not eligible for payment unless the patient has an established diagnosis of a
        chronic complex neurological disease, documented in the patient’s medical record.
      5.E078 is not eligible for payment with A113.
      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.A complex neurological assessment is for the ongoing management of complex neurological
        disorders, where the complexity of the condition requires the continuing management by a
        neurologist. It is not intended for the evaluation and/or management of uncomplicated
        neurological disorders (e.g. carpal tunnel syndrome, Bell’s palsy, asymptomatic diabetic
        neuropathy).
      2.A consultation or assessment service, as appropriate, may be claimed for the initial
        evaluation of a patient. A complex neurological assessment is for the ongoing management
        of a patient with a complex neurological disorder.]
   Consultation and Management for Acute Cerebral Vascular Syndrome (ACVS)
     A Consultation and Management for ACVS is a service in which the physician provides all the
     elements of a consultation (A185) to a patient referred for suspected ACVS and, if necessary,
     treatment with intravenous thrombolysis therapy and post-administration monitoring.
 A384 ................................................................................................ 275.95
 K181 - after first 30 minutes, must include intravenous thrombolysis
          therapy and monitoring, per 30 minute unit (or major part
          thereof) ...............................................................................      90.00
     Medical record requirements:
     Consultation and Management for ACVS is only eligible for payment if start and stop times of
     the services and the time of onset of symptoms are recorded in the patient's permanent
     medical record.

PDF page 271 / A143

CONSULTATIONS AND VISITS
 NEUROLOGY (18)
          Payment rules:
          1.A384 and K181 are only eligible for payment for patients seen within the timeframe for
            eligibility for intravenous thrombolysis therapy as defined by the Canadian Stroke Best
            Practices.
          2.A384 and K181 must be rendered in a hospital with CT or MRI facilities onsite.
          3.A384 and K181 are only eligible for payment to a specialist in Neurology (18).
          4.A384 and K181 are only eligible for payment if the physician remains in constant attendance
            with the patient.
          5.G521, G522, G523, or G391 are not eligible for payment with A384 or K181.
          6.K181 is only eligible for payment for patients treated with intravenous thrombolysis therapy
            as defined by the Canadian Stroke Best Practices.
          7.K181 is limited to a maximum of 6 units per patient per day.
          [Commentary:
          The Canadian Stroke Best Practices can be found at the following link: https://
          www.strokebestpractices.ca/recommendations/acute-stroke-management/acute-ischemic-
          stroke-treatment ]

PDF page 272 / A144

CONSULTATIONS AND VISITS
NEUROLOGY (18)
     EMERGENCY OR OUT-PATIENT DEPARTMENT (OPD)
      Physician in hospital but not on duty in the Emergency Department when seeing patients in the
      Emergency or OPD - use General Listings.
   NON-EMERGENCY HOSPITAL IN-PATIENT SERVICES
     See General Preamble GP40 to GP48. For emergency calls and other special visits to in-
     patients, use General Listings and Premiums when applicable - see General Preamble GP65
     to GP78.
 C185 Consultation............................................................................   225.55
 C180 Special neurology consultation - subject to the same conditions
          as A180 .............................................................................. 342.25
 C682 Extended special neurology consultation - subject to the same
          conditions as A682 .............................................................       442.40
 C384 Consultation and Management for ACVS - subject to the same
          conditions as A384 .............................................................       275.95
 C385 Limited consultation ................................................................      125.50
 C186 Repeat consultation ................................................................       125.50
 C183 Medical specific assessment ..................................................              82.40
 C184 Medical specific re-assessment..............................................                64.95
 C181 Complex medical specific re-assessment...............................                       75.20
 C113 Complex neurological assessment - subject to the same
          conditions as A113 .............................................................       120.00
   Subsequent visits
 C182 - first five weeks........................................................ per visit                        40.05
 C187 - sixth to thirteenth week inclusive (maximum 3 per patient
        per week)................................................................ per visit                       40.05
 C189 - after thirteenth week (maximum 6 per patient per month)
         ............................................................................... per visit                40.05
   Subsequent visits by the Most Responsible Physician (MRP)
    See General Preamble GP44 to GP45 for terms and conditions.
 C122 - day following the hospital admission assessment..............                                             71.80
 C123 - second day following the hospital assessment ..................                                           71.80
 C124 - day of discharge .................................................................                        71.80
 C126 - day of discharge, medically complex patient (see A13 for
        terms and conditions) ........................................................                            95.10
   Subsequent visits by the MRP following transfer from an Intensive Care Area
    See General Preamble GP46 for terms and conditions.
 C142 - first subsequent visit by the MRP following transfer from an
        Intensive Care Area............................................................    71.80
 C143 - second subsequent visit by the MRP following transfer from
        an Intensive Care Area.......................................................      71.80
 C121 Additional visits due to intercurrent illness (see General
        Preamble GP43)..................................................... per visit      40.05
 C188 Concurrent care .......................................................... per visit 40.05
 C982 Palliative care (see General Preamble GP50)............ per visit                    40.05

PDF page 441 / J27

DIAGNOSTIC AND THERAPEUTIC PROCEDURES
 CRITICAL CARE
                                                                                              Fee
          3. "Life threatening critical care" is not eligible for payment for the services of a physician
            rendered to the same patient on the same day for which the physician is paid a per diem fee
            for Critical Care (intensive care area), Ventilatory Support, Comprehensive Care or Neonatal
            Intensive Care.
          4. Consultation or assessments rendered before or after provision of "life threatening critical
            care" may be eligible for payment on a fee-for-service basis but not when claiming Critical
            Care (intensive care area), Ventilatory Support, Comprehensive Care or Neonatal Intensive
            Care per diem fees.
          5. G521, G522, G523, or G391 are not eligible for payment with A384 or K181.
          Medical record requirements:
          The service is eligible for payment only if start and stop times of the service are recorded in the
          patient's permanent medical record.
          [Commentary:
          Time unit total may include time which is consecutive or non-consecutive.]

Master, record 184. Record Layout PDF, page 1.

A38420260401999999990000000000000000000000000027595000000000000000000000000

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.