G064

PDF page 487 / J73

Management and supervision of outpatient continuous nerve block infusion or outpatient
palliative epidural infusion
In addition to the common elements, the components of this service include the following specific
elements:
A. Monitoring the condition of a patient with respect to the continuous nerve block infusion.
B. Adjusting the dosage of the infusion therapy and, where appropriate, prescribing other therapy.
C. Discussion with, and providing advice and information to the patient, patient’s relative(s), patient
   representative or other caregiver(s), by telephone or otherwise, on matters related to the service,
   regardless of the identity of the person initiating the discussion.
D. Making arrangements for any related assessments, procedures or therapy and interpreting results
   as appropriate.
E. Providing premises, equipment, supplies and personnel for the specific elements.
   G064 Management and supervision of outpatient continuous nerve
          block infusion.......................................................... per day   20.00
          Payment rules:
          1. G064 is only eligible for payment when:
               a.rendered by the physician most responsible for the patient’s care or by a physician
                 substituting for that physician (the “substitute physician”); and
               b.the clinical decision(s) pertaining to the medical advice, direction or information provided
                 is formulated personally by the physician or substitute physician.
          2. G064 is only eligible for payment for a day when one or more components of element C are
            rendered in that day.
          3. G064 rendered on the same day as a consultation or visit by the same physician is not
            eligible for payment.
          4. G064 is limited to a maximum of 7 services per patient per G279 service.
          Medical record requirements:
          A dated summary of each contact must be recorded in the patient’s permanent medical record
          or the service is not eligible for payment.

PDF page 490 / J76

Epidural and spinal injections
      Percutaneous epidural injections
# G246 Lumbar....................................................................................                150.00
# G117 Thoracic ..................................................................................               170.00
# G119 Cervical...................................................................................               190.00
# G918 Caudal ....................................................................................                74.20
  E440    - with injection of contrast using fluoroscopy, to G246, G117,
            G119 or G918 ............................................................ add                         30.00
  E441    - when performed at same level of previous spinal surgery,
            to G246, G117, G119 or G918 ................................... add                                   16.60
  E442    - when performed using a transforaminal technique, to
            G246, G117, G119 or G918 ....................................... add                                  20.00
  E443    - with catheter for continuous infusion, to G246, G117, G119
            or G918 ...................................................................... add                    80.00
# E833    - with insertion of subcutaneous port, G117, G119, G246 or
            G918 .......................................................................... add                  116.10
         Payment rules:
         1. Percutaneous epidural injections are limited to 12 services per patient per 12 month period
           for any combination of G119, G117, G246 and G918. If, in the opinion of the treating
           physician, more frequent treatments are necessary, the physician may obtain written prior
           authorization from the MOH. Authorization will be dependent on the physician demonstrating
           that the increased frequency of the service is generally accepted as necessary for the patient
           under the circumstances.
         2. G246, G117, G119 or G918 are only eligible for payment same patient same day with G236,
           G234 and G920 if rendered to diagnose or treat a separate condition.
         [Commentary:
         The sympathetic block that may result from an epidural injection is not payable as G920, G234
         or G236.]
         3. G246, G117, G119 or G918 are not eligible for payment with any concurrent surgical
           procedure or any anaesthetic fee, except for E030C or E031C when indicated as described
           in the General Preamble Anaesthesiologist Services.
         [Commentary:
         1.For initiation and management services for outpatient palliative epidural infusion, refer to
           G063 and G064 page J73.
         2.For epidural blood patch, refer to G068 and G065 page J72.]
  G245 Lumbar epidural or intrathecal injection of sclerosing solution                                           180.00
  G239 Differential intrathecal spinal block .........................................                           127.60
# G919 Percutaneous epidural adhesiolysis by infusion with
          fluoroscopic guidance.........................................................                         400.00
         Note:
         G919 is only eligible for payment if the following conditions are met:
         1.it is used for the treatment of epidural fibrosis with symptoms of persistent back or radicular/
           neuropathic leg pain following spinal surgery;

Master, record 1841. Record Layout PDF, page 1.

G06420250401999999990000020000000000000000000000000000000000000000000000000

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.