A888

PDF page 17 / GP3

GENERAL PREAMBLE
 DEFINITIONS
        Dental Surgeon a health care practitioner who meets the definition of “dental surgeon” as set
                       out in Regulation 552 under the Act, and who has been issued an OHIP
                       registration number.
        emergency                 an office or other place, including Urgent Care Centres, Walk-in Clinics,
        department                Extended Hours Clinics, or other settings (other than a hospital emergency
        equivalent                department) in which the only insured services provided are to patients who
                                  do not have pre-arranged appointments
        general                   all forms of anaesthesia except topical anaesthesia or local infiltration
        anaesthesia
        “H” fee                   a fee set out in the Schedule for the technical component of a diagnostic
                                  service provided either in a hospital or in an offsite premise operated by the
                                  hospital corporation that has received approval under section 4 of the Public
                                  Hospitals Act
        holiday (for other than “H” prefix emergency department listings and Emergency
        Department Equivalent - A888) means all of the following:
                1. Family Day, Good Friday, Victoria Day, Canada Day, Civic Holiday, Labour Day,
                   Thanksgiving, New Year’s Day, and if the holiday falls on a Saturday or Sunday either
                   the Friday before or the Monday following the holiday, as determined at the choice of the
                   physician.
                2. Boxing Day and if Boxing Day falls on a Saturday, the Monday following Boxing Day.
                3. Christmas Day and
                    a. if Christmas Day falls on a Sunday, the Friday before Christmas Day;
                       or
                      b. if Christmas Day falls on a Saturday, the Friday before and the Monday following
                         Christmas Day.
        holiday (for “H” prefix emergency department listings and Emergency Department
        Equivalent - A888) means all of the following:
        Family Day, Good Friday, Victoria Day, Canada Day, Civic Holiday, Labour Day,
        Thanksgiving, New Year’s Day, December 25 through December 31 (inclusive) and,
                a. if Christmas Day falls on a Saturday or Sunday, the Friday before Christmas Day;
                   and
                      b. if New Year’s Day falls on a Saturday or Sunday, the Monday following New Year’s
                         Day;
                         and
                      c. if Canada Day falls on a Saturday or Sunday either the Friday before or the Monday
                         following Canada Day, as determined at the choice of the physician.
          [Commentary:
          1.Only services rendered on a holiday as defined above and listed as a holiday premium or
            service, e.g. certain special visit premiums, after-hours premiums and H-code emergency
            department services, are eligible for payment as holiday claims.
          2.Special visit premiums are not eligible for payment with A888.]

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 133 / A5

CONSULTATIONS AND VISITS
 FAMILY PRACTICE & PRACTICE IN GENERAL (00)
          Payment rules:
          1.For definitions and payment rules - see General Preamble GP21.
          2.E089 is only eligible for payment when the patient’s gender identity is documented in the
            patient’s medical record.
     Emergency department equivalent - partial assessment
       An emergency department equivalent - partial assessment is an assessment rendered in an
       emergency department equivalent on a Saturday, Sunday or Holiday for the purpose of dealing
       with an emergency.
   A888 Emergency department equivalent - partial assessment ........              44.55
       [Commentary:
       For services described by emergency department equivalent - partial assessment, the only fee
       code payable is A888.]
          Payment rules:
          1.Hypnotherapy or counselling rendered to the same patient by the same physician on the
            same day as A888 are not eligible for payment.
          2.No premiums are payable for a service rendered in an emergency department equivalent.

Master, record 309. Record Layout PDF, page 1.

A88820260401999999990000044550000000000000000000000000000000000000000000000

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.