A585

PDF page 260 / A132

Comprehensive laboratory medicine consultation
                   This service is a consultation rendered by a specialist in laboratory medicine who provides all
                   the appropriate elements of a consultation and spends a minimum of 75 minutes in direct
                   contact with the patient, exclusive of time spent rendering any other separately billable
                   intervention to the patient.
               A580 Comprehensive laboratory 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.A580 must satisfy all the elements of a consultation (see page GP16).
                                          2.Unless otherwise specified in the Schedule, the calculation of time for comprehensive
                                            laboratory 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.]
                 Diagnostic consultation
                   A diagnostic laboratory medicine consultation is the service rendered when tissue, slides,
                   specimens and/or laboratory results prepared in one licensed laboratory are referred to a
                   laboratory medicine physician not in the same licensed laboratory for a written opinion. The
                   specific elements are the same as for the L800 series of codes (see page J60 to J62).
               A585 Diagnostic consultation........................................................... 106.50
                   Payment rules:
                   1.A diagnostic laboratory medicine consultation is not eligible for payment when tissues, slides,
                     specimens and/or laboratory results from a different licensed laboratory are used for
                     comparison purposes with tissues, slides, specimens and/or laboratory results done in the
                     consultant’s licensed laboratory.
                                          2.With the exception of those services set out in the section, “Special Procedures and
                                            Interpretation – Histology or Cytology”, any other services rendered by the physician in
                                            association with a diagnostic laboratory medicine consultation are not eligible for payment.

PDF page 261 / A133

CONSULTATIONS AND VISITS
 LABORATORY MEDICINE (28)
     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.
   C285 Consultation............................................................................    163.00
   C286 Limited consultation ................................................................       108.95
   C586 Repeat consultation ................................................................        110.00
   C283 Medical specific assessment ..................................................               82.50
   C580 Comprehensive laboratory medicine consultation – subject to
           the same conditions as A580 .............................................                342.25
   C585 Diagnostic consultation - subject to the same conditions as
           A585 ................................................................................... 106.50
   C288 Concurrent care .......................................................... per visit         30.10

PDF page 476 / J62

DIAGNOSTIC AND THERAPEUTIC PROCEDURES
LABORATORY MEDICINE
   L866 SURGICAL PATHOLOGY, LEVEL 6.
    Gross and microscopic examination of the following specimens:
    Bone (resection); breast (mastectomy with regional lymph nodes); colon (segmental resection
    for neoplasm); colon (total resection); extremity (disarticulation); fetus (with dissection); larynx
    (partial or total resection with regional lymph nodes); lung (partial or total resection);
    oesophagus (partial or total resection); pancreas (partial or total resection); prostate (radical
    resection); small intestine (resection for neoplasm); soft tissue neoplasm (extensive resection);
    stomach (partial or total resection for neoplasm); testis (neoplasm); tongue (resection for
    neoplasm); tonsil (resection for neoplasm); urinary bladder (partial or total resection); uterus
    with or without fallopian tubes and ovaries (neoplasm other than leiomyoma); vulva (partial or
    total resection).
   L867 SURGICAL PATHOLOGY
    Gross and microscopic examination of specimens not listed in Levels 2 through 6.
    Payment rules:
    1. The unit of a service in Surgical Pathology and Cytopathology is a specimen. A specimen is
      tissue that is identified and submitted for individual and separate examination and diagnosis.
    [Commentary:
    Surgical Pathology codes L861 through L866 denote increasing levels of physician work
    associated with examination of the specimens listed in the respective service code definitions.]
    2. When the examination of a specimen requires any of the services listed under Special
      Procedures and Interpretation - Histology or Cytology, such services are eligible for payment
      in addition to any of the following services (when rendered):
        a.services listed under Anatomic Pathology - Surgical Pathology,
        b.services listed under Anatomic Pathology – Cytopathology; or
        c.a Diagnostic Laboratory Medicine Consultation (A585/C585) as listed in the "Consultation
          and Visits" section of the Schedule.
    3. Cytology smears fees are payable in each case for which the physician is responsible
      whether or not all slides are personally examined by the physician.
    [Commentary:
    1.For the technical components of Laboratory Medicine (L001 to L799 and L900 codes), please
      refer to the separate Schedule of Benefits for Laboratory Services.
    2.See section 37.1 of regulation 552 under the Health Insurance Act for additional information
      regarding payment and insurability of Laboratory services.]

Master, record 233. Record Layout PDF, page 1.

A58520260401999999990000000000000000000000000010650000000000000000000000000

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.