G315

PDF page 25 / GP11

Payment for Diagnostic and Therapeutic Services Rendered at a Hospital
  The technical component of a diagnostic and therapeutic service listed below and rendered in a
  hospital is payable at 86.10% of the listed fee in the column headed “T”.
  G104A, G111A, G121A, G127A, G140A, G143A, G146A, G149A, G152A, G153A, G167A,
  G174A,G181A, G209A, G284A, G308A, G310A, G311A, G315A, G414A, G440A, G441A, G442A,
  G443A,G448A, G451A, G455A, G466A, G471A, G519A, G540A, G541A, G542A, G544A, G554A,
  G570A,G574A, G582A, G585A, G647A, G648A, G651A, G652A, G654A, G655A, G682A, G683A,
  G684A,G685A, G686A, G687A, G688A, G689A, G694A, G695A, G815A, G850A, G851A, G852A,
  G853A,G854A, G855A, G856A, G857A, G858A, J301B, J304B, J324B, J327B

PDF page 414 / H6

PULMONARY FUNCTION STUDIES
                                                                                                   H            P
  Oxygen saturation
J323 - by oximetry at rest, with or without O2................................                     4.20         -
J332 - by oximetry at rest and exercise, or during sleep with or
       without O2...........................................................................     17.60         11.35
J334 - J332 with at least two levels of supplemental O2 ...............                          30.55         16.85
J336 - with single blind assessment of exercise on room air and
       with supplemental oxygen ..................................................               30.55         16.85
      Note:
      1.J323 is not eligible for payment when rendered with J332, J315, J316, G315, G319, G111,
        G112, G570, G571, G582, G583, G574, G575 or any overnight sleep study.
      2.J332 is not eligible for payment when rendered with J315, J316, G315, G319, G111, G112,
        G570, G571, G582, G583, G574, G575 or any overnight sleep study.
      3.J336 is only eligible for payment for evaluation of a patient to determine eligibility for funding
        under the Ontario Home Oxygen Program.
      4.J336 is not payable in addition to J332 or J334.
      5.J301, J304, J324, or J327 are not eligible for payment when rendered to a patient who does
        not have symptoms, signs or an indication supported by current clinical practice guidelines
        relevant to the individual patient’s circumstances.
      Medical record requirements:
      J323, J332, J334 or J336 are not eligible for payment unless a permanent record of the study is
      maintained.
J322 Standard O2 consumption and CO2 production......................                              5.30          6.45
J333 Non-specific bronchial provocative test (histamine,
       methacholine, thermal challenge) ......................................                   48.25         41.55
J335 Antigen challenge test ............................................................         51.85         30.95
                                                                                                              Fee
Z459 Arterial puncture for blood gas analysis..................................                               10.20
    Note:
    For home/self-care ventilation listing - see Diagnostic and Therapeutic Procedures page J50.

PDF page 429 / J15

STRESS TESTING
        Maximal stress ECG
         Maximal stress ECG (exhaustion, symptoms or ECG changes) or submaximal stress ECG (to
         target heart rate for patient) by a standard technique - with treadmill or ergometer and
         oscilloscopic continuous monitoring including ECGs taken during the procedure and resting
         ECGs before and after the procedure - physician must be in attendance at all times. The
         professional component includes the necessary clinical assessment immediately prior to
         testing.
   G315        - technical component ..........................................................       50.55
   G319        - professional component .....................................................                 62.05
     Dobutamine stress test
   G174   - technical component, when rendered outside of hospital
            ................................................................................... add   54.25
     Dipyramidole Thallium stress test
   G111 - technical component .......................................................... 58.95
   G112 - professional component .....................................................         74.25
       Note:
       1.The technical and professional fee components for maximal stress ECG are not eligible for
         payment in the routine preoperative preparation or screening of a patient for surgery where
         the patient will undergo a low risk procedure or has a low risk of perioperative cardiac
         complications, unless there is a clinical indication requiring a exercise stress test study other
         than solely for preoperative preparation of the patient.
          2.G315, G319, G174, G111 and G112 are uninsured services for routine annual stress tests in
            asymptomatic patients where the patient's 10 year risk of coronary heart disease is less than
            10% calculated by generally accepted methodology.
          [Commentary:
          An example of a generally accepted methodology for determining 10 year risk of coronary
          heart disease is the Framingham Risk Score.
          1.Studies have indicated that for non cardiac surgery, there may be no clinical benefit and
            there may be harm in performing functional cardiac testing in patients with low operative risk
            and little or limited benefit in moderate risk patients. BMJ 2010, Jan 28; 340.
          2.One example of a generally accepted guideline is the American College of Cardiology
            (ACC)/ American Heart Association (AHA) Guidelines that states:
              a.Non invasive testing could be considered in patients with 1 to 2 risk factors and poor
                functional capacity (less than 4 mets) who require intermediate risk surgery if it will
                change management (class IIb)
              b.Non invasive testing has not been show to be useful in patients with no clinical risk factors
                undergoing intermediate risk non cardiac surgery (class III).
              c.Non invasive testing has not been shown to useful in patients undergoing low risk non
                cardiac surgery (class III).]

Master, record 2027. Record Layout PDF, page 1.

G31520260401999999990000050550000000000000000000000000000000000000000000000

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.