G043

PDF page 72 / GP58

COUNSELLING
  Definition/Required elements of service:
  Counselling is a patient visit dedicated solely to an educational dialogue with a physician. This service
  is rendered for the purpose of developing awareness of the patient’s problems or situation and of
  modalities for prevention and/or treatment, and to provide advice and information in respect of
  diagnosis, treatment, health maintenance and prevention.
                                          [Commentary:
                                          1.Advice given to a patient that would ordinarily constitute part of a consultation, assessment,
                                            or other treatment, is included as a common or constituent element of the other service, and
                                            does not constitute counselling.
       2.Detention time may be payable following a consultation or assessment when a physician is
         required to spend considerable extra time in treatment or monitoring of the patient. See
         GP29 for further information.]
  Payment rules:
    1. With the exception of the codes listed in the below, no other services are eligible for payment
       when rendered by the same physician the same day as any type of counselling service:
       E080, G010, G039, G040, G041, G042, G043, G202, G205, G365, G372, G384, G385, G394,
       G462, G480, G489, G482, G538, G590, G593, G840, G841, G842, G843, G844, G845, G846,
       G847, G848, G849, H313, K002, K003, K008, K014, K015, K031, K035, K036, K038, K682,
       K683, K684, K730
                    2. Individual and group counselling services are limited to 3 units per patient per physician per
                       year at the higher fee (K013 or K040 respectively); the amount payable for services rendered in
                       excess of this limit will be adjusted to a lesser fee (K033 or K041 respectively).
                    3. If the patient does not have a pre-booked appointment, the amount payable for this service will
                       be adjusted to a lesser assessment fee.
  A. Individual Counselling
  Definition:
  Individual counselling is counselling rendered to a single patient.
  B. Group Counselling
  Definition:
  Group Counselling is counselling rendered to two or more patients with a similar medical condition or
  situation.
  Payment rules:
     1. Group counselling is only eligible for payment when all of the following conditions are fulfilled:

PDF page 481 / J67

B. Point of care drug testing
   G041 Target drug testing, urine, qualitative or quantitative .. per test             3.70
   G042 Target drug testing, urine, qualitative or quantitative .. per test             2.50
      [Commentary:
      G041 and G042 are tests for a specific drug of abuse.]
   G040 Drugs of abuse screen, urine, must include testing for at
          least four drugs of abuse........................................ per test   15.00
   G043 Drugs of abuse screen, urine, must include testing for at
          least four drugs of abuse........................................ per test    7.50
      [Commentary:
      Drugs of abuse may include any of the following: alcohol, methadone, methadone metabolite,
      morphine, a synthetic or semi-synthetic opiate, cocaine, benzodiazepines, amphetamines,
      methamphetamines, cannabinoids, barbiturates or any other drug of abuse.]
   G039 Creatinine ............................................................................... 1.03
      Payment rules:
      1. G040 and G041 are limited to a maximum of five (5) services per patient (any combination)
        per month to any physician when K682 or K683 is payable.
          2. G042 and G043 are limited to a maximum of four (4) services per patient (any combination)
            per month to any physician when K682 or K683 is payable.
          3. Any combination of G040, G041, G042 and G043 is limited to a maximum of three (3)
            services per patient per month for management of a patient with chronic pain, an addiction,
            or receiving opioid agonist treatment program where K682 or K683 is not payable in the
            month for the same patient to any physician.
          4. G040, G041, G042 and G043 are not eligible for payment unless K623 or K624 or a
            consultation, assessment or time–based service involving a direct physical encounter with
            the patient is payable in the same month to the same physician rendering the G040, G041,
            G042 or G043 service.
          5. G039 is limited to a maximum of two (2) tests per patient per week, any physician.
          6. G039 is only eligible for payment when rendered to rule out urine tampering.
          7. Only one of G040, G041, G042 or G043 is eligible for payment per urine sample.

Master, record 1835. Record Layout PDF, page 1.

G04320250401999999990000007500000000000000000000000000000000000000000000000

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.