G575

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 435 / J21

Complete Study - 1 and 2 dimensions
  Definition/Required elements of service:
  A Complete Study – 1 and 2 dimensions is an echocardiogram that must include as a minimum all of
  the following components: acquisition, recording and storage of ultrasound images relevant to the
  assessment of all components of cardiac structure and function including chambers, valves, septae,
  pericardium and proximal great vessels. Also included when rendered is a Cardiac Doppler Study
  (with or without colour Doppler).
                                          Note:
                                          Where one or more components of cardiac structure and function cannot be imaged due to
                                          circumstances beyond the physician’s control the echocardiogram is payable as a complete
                                          echocardiogram.
                  [Commentary:
                  If a single component of cardiac structure and function is imaged see G574/G575.]
               G570 - technical component .......................................................... 130.80
               G571 - professional component .....................................................          96.20
                  Medical record requirements:
                  G570 and G571 are only eligible for payment for an echocardiogram when:
                                          1.The required components and findings of a complete study are documented;
                                          2.There is a permanent recording on appropriate dynamic medium, either videotape or digitally,
                                            of the constituent images and measurements; and
                                          3.If applicable, a description of the circumstance beyond the physician’s control leading to one
                                            or more components of the echocardiogram not being rendered.
  Stress Study
  Definition/Required elements of service:
  A stress echocardiography study includes the following required elements:
                                              1. Initial baseline study of all components of cardiac structure and function including
                                                 chambers, valves and septae and may include a Cardiac Doppler Study (with or without
                                                 colour Doppler);
                                              2. Stress images which may include various stages of stress and must include relevant
                                                 peak or immediate post stress images relevant to the patient’s clinical and diagnostic
                                                 findings; and
                                              3. A simultaneous comparison of all left ventricular wall segments and global function
                                                 obtained from pre-stress and stress images.
                   [Commentary:
                   Stress images may be obtained when the stress is induced by exercise, pharmacologic agents
                   or pacing.]
                G582 - technical component .......................................................... 148.50
                G583 - professional component .....................................................          110.15
                   Payment rules:
                   G570, G571, G574 or G575 are not eligible for payment with G582 or G583.

PDF page 437 / J23

Definition/Required elements of service:
An examination limited to a single component of the cardiac assessment.
          [Commentary:
          Examples where a focused study may apply are:
          1.Emergency assessment to guide immediate patient management.
      2.Follow up within 2 weeks of a complete study to re-evaluate a specific finding or question.]
   G574 - technical component .......................................................... 18.65
   G575 - professional component .....................................................         13.95
          Medical record requirements:
          G574 and G575 are only eligible for payment for a focused echocardiography study when:
          1.The component of the cardiac assessment and findings are documented; and
          2.There is a permanent recording on appropriate dynamic medium, either videotape or digitally,
            of the constituent images and measurements.
     Echocardiography contrast
   G585 - technical component, with use of contrast agent, to G570 or
          G582............................................................................. add 147.25
          Payment rules:
          1. G585 is only eligible for payment with a complete study or stress study in difficult-to-image
            patients where:
             a.two or more contiguous segments are not seen on a recent non-contrast echocardiogram
               images;
             b.the contrast agent is bubble-based with a diameter 5 microns or less, with resonance
               frequencies in the diagnostic ultrasound range and the contrast agent is able to cross the
               pulmonary circulation; and
             c.professional component G571 or G583 is eligible for payment for the same
               echocardiography study.
          2. G585 is only eligible for payment if the physician performing the service establishes he/she:
             a.has Level III (advanced) echocardiography training, with experience in administering and
               interpretation of contrast echocardiography; or
             b.has Level II (basic prerequisites for independent competence in echocardiography)
               training, plus additional training in contrast echocardiography to learn the appropriate
               techniques for administering contrast agents and interpreting contrast-enhanced
               echocardiograms.
             c.Started practice prior to January 1, 1990 and:
               i. was trained to applicable echocardiography standards at the time of starting practice;
               ii. has rendered and been paid for echocardiography services regularly since January 1,
                    1990;
               iii. has rendered and been paid for at least 1800 echocardiograms in total in the 36
                    months prior to September 1, 2011; and

Master, record 2280. Record Layout PDF, page 1.

G57520250401999999990000013950000000000000000000000000000000000000000000000

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.