A902

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.

PDF page 135 / A7

CONSULTATIONS AND VISITS
 FAMILY PRACTICE & PRACTICE IN GENERAL (00)
        On-call admission assessment
          On-call admission assessment is the first hospital in-patient admission general assessment per
          patient per 30-day period if:
         a. the physician is a general practitioner or family physician participating in the hospital’s on-
            call roster whether or not the physician is on-call the day the service is rendered;
         b. the admission is non-elective; and
      c. the physician is the most responsible physician with respect to subsequent in-patient care.
       The amount payable for any additional on-call admission assessment rendered by the same
       physician to the same patient in the same 30-day period is reduced to the amount payable for a
       general re-assessment.
   A933 On-call admission assessment ...............................................  82.00
     General/Family physician emergency department assessment
       General/Family physician emergency department assessment is an assessment of a patient
       that satisfies as a minimum the requirements of an intermediate assessment and is rendered
       by the patient's general/family physician in an emergency department funded under an
       Emergency Department Alternative Funding Agreement (ED-AFA). For that visit, the service
       includes any re-assessment of the patient by the general/family physician in the emergency
       department and any appropriate collaboration with the emergency department physician.
       The service is only eligible for payment when the general/family physician's attendance is
       required because of the complexity, obscurity or seriousness of the patient's condition.
   A100 General/Family physician emergency department assessment                        78.95
       Payment rules:
       No other service (including special visit or other premiums) rendered by the same physician to
       the same patient during the same visit to the emergency department is eligible for payment with
       this service.
          Claims submission instructions:
          For claims payment purposes, the hospital master number associated with the emergency
          department must be submitted on the claim.
          [Commentary:
          1.Services described as A100 rendered in an emergency department not funded under an ED-
            AFA may be payable under other existing fee schedule codes.
          2.In the event the patient is subsequently admitted to hospital, and the general/family physician
            remains the MRP for the patient, the General/Family Physician emergency department
            assessment constitutes the admission assessment. see General Preamble GP41 for
            additional information.]
     Certification of death
       Certification of death is payable to the physician who personally completes the death certificate
       on a patient who has been pronounced dead by another physician, medical resident or other
       authorized health professional. Claims submitted for this service must include the diagnostic
       code for the underlying cause of death as recorded on the death certificate. The service may
       include any counselling of relatives that is rendered at the same visit. Certification of death
       rendered in conjunction with A902 or A777/C777 is an insured service payable at nil.
   A771 Certification of death............................................................... 24.20

Master, record 313. Record Layout PDF, page 1.

A90220260401999999990000064800000000000000000000000000000000000000000000000

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.