G379

PDF page 65 / GP51

Definition/Required Elements of Service:
  Monthly Management of a Nursing Home or Home for the Aged Patient is the provision by the most
  responsible physician (MRP) of routine medical care, management and supervision of a patient in a
  nursing home or home for the aged for one calendar month. The service requires a minimum of two
  assessments of the patient each month, where these assessments constitute services described as
  "W" prefix assessments.
  The requirements above are subject to the exceptions as described in payment rule #8.
         [Commentary:
         As with all services described as assessments, direct physical encounter with the patient is
         required.]
  In addition to the common elements, this service includes the provision of the following services by
  any physician to the same patient during the month.
  A. Services described by subsequent visits (e.g. W003, W008).
  B. Services described by additional visits due to “intercurrent illness” (W121) except if the conditions
     described in Payment rule #7 are satisfied.
  C. Services described by palliative care subsequent visits (e.g. W872).
  D. Services described by admission assessments (e.g. W102, W104, W107).
  E. Services described by periodic health visit or general re-assessments (e.g. W109, W004).
  F. Services described by visit for pronouncement of death (W777) or certification of death (W771)
     except if the services are performed in conjunction with a special visit.
  G. Service described by anticoagulation supervision (G271).
  H. Completion of home care referral form and home care supervision (K070, K071, K072).
  I. Services described by the following diagnostic and therapeutic procedures – venipuncture (G489),
     injection (G372, G373), immunization (G538, G590, G849), collection of cervical cancer screening
     specimen(s) (G365, G394, E430, E431), intravenous (G379), and laboratory test codes (G001,
     G002, G481, G004, G005, G009, G010, G011, G012, G014).
  J. All medication reviews.
  K. All discussions with the staff of the institution related to the patient’s care.
  L. All telephone calls from the staff of the institution, patient, patient’s relative(s) or patient’s
     representative in respect of the patient between the hours of 0700 hours and 1700 hours Monday
     to Friday (excluding holidays).
  M.Ontario Drug Benefit Limited Use prescriptions/forms or Section 8 Ontario Drug Benefits Act
    requests.

PDF page 118 / GP104

GENERAL PREAMBLE
OTHER PREMIUMS
    Non-elective Surgical Procedures (including fractures or dislocations), Obstetrical Deliveries,
    Clinical Procedures Associated with Diagnostic Radiological Examinations, Ground Ambulance
    Transfer (K101), Air Ambulance Transfer (K111), Transport of Donor Organs (K102), Return
    Trip (K112), or one of the following Major Invasive Procedures:
    G060, G061, G062, G065, G066, G067, G068, G082, G083, G085, G090, G099, G117, G118,
    G119, G125, G176, G177, G178, G179, G211, G224, G246, G248, G249, G260, G261, G262,
    G263, G268, G269, G275, G277, G279, G280, G282, G287, G288, G290, G297, G298, G303,
    G309, G322, G323, G324, G330, G331, G336, G347, G348, G349, G356, G376, G379, G380,
    G509, J001 to J068, and X112 when required for intussusception

PDF page 469 / J55

INTRAVENOUS
  + G376 Newborn or infant ................................................................... 10.20
  + G379 Child, adolescent or adult .......................................................     6.15
        Note:
        1.G376 or G379 apply to cryoprecipitate infusion.
        2.G376 or G379 may not be claimed with x-rays as they are included in the service.
        3.Except for G381, injections into established I.V. apparatus may not be claimed.
               G389 Preparation and infusion of gamma globulin, per patient, per
                      day......................................................................................           13.90
  + G380 Cutdown including cannulation as necessary.........................                                              27.05
    G387 Intravenous local anaesthetic infusion for central neuropathic
            pain.....................................................................................                   125.00
                                          Payment rules:
                                          1. G387 is only insured for patients with central neuropathic pain who have first undertaken but
                                            not responded to generally accepted medical therapy.
                                          2. The physician submitting the claim for this service must remain in constant attendance
                                            during the infusion and no part of the procedure may be delegated or G387 is not payable.
                                          3. G387 is limited to a maximum of 6 per patient per 12 month period.
                                          Medical record requirements:
                                          The medical record for the service must document the prior medical therapy that the patient did
                                          not respond to or G387 is not eligible for payment.

PDF page 510 / J96

If the patient's clinical condition meets all the above criteria but retinal photographs are not
    made prior to the procedure and retained on the patient's permanent medical record or the
    procedure is not performed by an ophthalmologist, then PDT is not eligible for payment.
    Maximum one PDT (unilateral or bilateral) per patient per day.
G460 Unilateral PDT per patient .......................................... per day  330.00
G461 Bilateral PDT per patient............................................. per day 500.00
   Note:
   1.G379 rendered to same patient in conjunction with G460 or G461 is an insured service
     payable at nil.
    2.G460 rendered to same patient same day as G461 is an insured service payable at nil.
    3.Assessments and angiography are payable in addition to PDT. Retinal photography is
      insured as a specific element of the assessment and is not payable separately.
    [Commentary:
    1.PDT will normally not be administered to each affected eye more frequently than once every
      3 months.
    2.PDT performed for treatment of clinical conditions other than described above is uninsured.]

Master, record 2091. Record Layout PDF, page 1.

G37920250401999999990000006150000000000000000000000000000000000000000000000

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.