A510

PDF page 304 / A176

CONSULTATIONS AND VISITS
PHYSICAL MEDICINE & REHABILITATION (31)
   Complex neuromuscular assessment
     A complex neuromuscular assessment is an assessment for the ongoing management of the
     following diseases of the neuromuscular system where the complexity of the condition requires
     the continuing management by a physical medicine and rehabilitation specialist:
         a.generalized peripheral neuropathies;
         b.myopathies;
         c.diseases of the neuromuscular junction; or
         d.diseases of the motor neurone
 A510 Complex neuromuscular assessment.....................................      104.85
     Payment rules:
     1.A complex neuromuscular 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 neuromuscular 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.E078 is not eligible for payment with A510.
     [Commentary:
     1. A complex neuromuscular assessment is for the ongoing management of complex
       neuromuscular disorders, where the complexity of the condition requires the continuing
       management by a physical medicine and rehabilitation specialist. It is not intended for the
       evaluation and/or management of uncomplicated neuromuscular 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 neuromuscular assessment is for the ongoing
       management of a patient with a complex neuromuscular disorder.]
    Complex physiatry assessment
      This service is an assessment in relation to the following diseases where the complexity of the
      condition requires the ongoing management by a physical medicine and rehabilitation
      specialist:
     a. traumatic brain injury;
     b. stroke (hemorrhagic and ischemic); or
     c. spinal cord injury.
 A511 Complex physiatry assessment .............................................. 114.80
     Payment rules:
     1.A complex physiatry assessment must include the elements of a medical specific re-
       assessment, or the amount payable will be adjusted to a lesser assessment fee.
     2.Complex physiatry 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.
     3.E078 is not eligible for payment with A511.

PDF page 306 / A178

CONSULTATIONS AND VISITS
PHYSICAL MEDICINE & REHABILITATION (31)
     EMERGENCY OR OUT-PATIENT DEPARTMENT (OPD)
      Physician in hospital but not on duty in the Emergency Department when seeing patient(s) 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.
 C315 Consultation............................................................................ 233.65
 C425 Comprehensive physical medicine and rehabilitation
          consultation – subject to the same conditions as A425......                          342.25
 C515 Limited consultation ................................................................    106.60
 C316 Repeat consultation ................................................................     106.60
 C313 Medical specific assessment ..................................................            86.40
 C314 Medical specific re-assessment..............................................              75.90
 C311 Complex medical specific re-assessment...............................                     82.75
 C510 Complex neuromuscular assessment - subject to the same
          conditions as A510 .............................................................     104.85
 C511 Complex physiatry assessment - subject to the same
          conditions as A511 .............................................................     114.80
   Subsequent visits
 C312 - first five weeks........................................................ per visit                        40.05
 C317 - sixth to thirteenth week inclusive (maximum 3 per patient
        per week)................................................................ per visit                       40.05
 C319 - 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
 C318 Concurrent care .......................................................... per visit                        40.05
 C982 Palliative care (see General Preamble GP50)............ per visit                                           40.05

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CONSULTATIONS AND VISITS
      PHYSICAL MEDICINE & REHABILITATION (31)
                 NON-EMERGENCY LONG-TERM CARE IN-PATIENT SERVICES
                  Non-Emergency Long-Term Care In-Patient Services includes Chronic Care Hospitals,
                  Convalescent Hospitals, Nursing Homes, Homes for the Aged, designated chronic or
                  convalescent care beds in hospitals and nursing homes or homes for the aged, other than
                  patients in designated palliative care beds. For emergency calls and other special visits to in-
                  patients, use General Listings and Premiums when applicable - see General Preamble GP65
                  to GP78.
               W515 Consultation............................................................................ 233.65
               W425 Comprehensive physical medicine and rehabilitation
                       consultation - subject to the same conditions as A425.......                          342.25
               W310 Limited consultation ................................................................    106.60
               W516 Repeat consultation ................................................................     106.60
               W510 Complex neuromuscular assessment - subject to the same
                       conditions as A510 .............................................................      104.85
               W511 Complex physiatry assessment - subject to the same
                       conditions as A511..............................................................      114.80
                 Admission assessment
               W512 - Type 1.................................................................................   69.35
               W514 - Type 2.................................................................................   20.60
               W517 - Type 3.................................................................................   30.70
               W419 Periodic health visit................................................................. 65.05
               W314 General re-assessment of patient in nursing home*...............                       20.60
                  Note:
                  *May only be claimed 6 months after Periodic health visit (as per the Nursing Homes Act).

Master, record 224. Record Layout PDF, page 1.

A51020260401999999990000000000000000000000000010485000000000000000000000000

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.