A900

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 134 / A6

CONSULTATIONS AND VISITS
      FAMILY PRACTICE & PRACTICE IN GENERAL (00)
                     Complex house call assessment
                      A complex house call assessment is a primary care service rendered in a patient's home to a
                      patient that is considered either a frail elderly patient or a housebound patient. The service
                      provided must satisfy, at a minimum, all of the requirements of an intermediate assessment.
                   A900 Complex house call assessment.............................................       64.80
                      Payment rules:
                      1.A complex house call assessment is only eligible for payment for the first person seen during
                        a single visit to the same location.
                                          2.A900 is not eligible for payment unless the patient is a frail elderly patient or a housebound
                                            patient.
                                          Note:
                                          1.For the purposes of A900, a frail elderly patient is a patient who is 65 years of age or over
                                            who has one or more of the following:
                                             a.Complex medical management needs, that may include polypharmacy;
                                             b.Cognitive impairment (e.g. dementia or delirium);
                                             c.Age-related reduced mobility or falls; or
                                             d.Unexplained functional decline not otherwise specified.
                                          2.For the purposes of A900, a housebound patient is a patient who meets all the following
                                            criteria:
                                             a.The person has difficulty in accessing office-based primary health care services because
                                                of medical, physical, cognitive, or psychosocial needs/conditions;
                                             b.Transportation and other strategies to remedy the access difficulties have been
                                                considered but are not available or not appropriate in the person's circumstances; and
                                             c.The person's care and support requirements can be effectively and appropriately
                                                delivered at home.
                                          [Commentary:
                                          1.A900 is payable when rendered in the patient's home or an assisted living or retirement
                                            residence.
                                          2.A900 is not payable when rendered in a long-term care home.]
                                          Medical record requirements:
                                          Complex house call assessment is not payable if the medical record does not:
                                          1.Demonstrate that an intermediate assessment was rendered; and
                                          2.Demonstrate that the patient was a frail elderly or housebound patient.
                     House call assessment - Pronouncement of death in the home
                      A house call assessment - Pronouncement of death in the home is the service rendered when
                      a physician pronounces a patient dead in a home. This service includes completion of the
                      death certificate and counselling of any relatives which may be rendered during the same visit.
                   A902 House call assessment - Pronouncement of death in the home                  64.80
                      Claims submission instructions:
                      Submit the claim using the diagnostic code for the underlying cause of death as recorded on
                      the death certificate.
                                          Note:
                                          For special visit premiums, please see pages GP65 to GP78 of the General Preamble.

Master, record 311. Record Layout PDF, page 1.

A90020260401999999990000064800000000000000000000000000000000000000000000000

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.