H313

PDF page 68 / GP54

SPECIFIC ELEMENTS
In addition to the common elements, all Psychotherapy, Hypnotherapy, Counselling, Primary Mental
Health, and Psychiatric Care include the following specific elements.
A. Performing the appropriate therapy or interaction (described below) with the patient(s) or, in the
   case of K014, K015, and H313, the patient’s relative(s) or patient’s representative, which may
   include the appropriate inquires (including obtaining a patient history, and a brief physical
   examination) carried out in order to arrive at an opinion as to the nature of the patient’s condition
   (whether such inquiry takes place before, during or after the encounter during which the therapy or
   other interaction takes place); any appropriate procedure(s), related service(s), and/or follow-up
   care.
B. Performing any procedure(s) during the same encounter as the therapy or other interaction unless
   the procedure(s) is(are) separately listed in the Schedule and an amount is payable for the
   procedure in conjunction with the therapy or interaction.
C. Making arrangements for any related assessments, procedures, or therapy.
D. Making arrangements for follow-up care.
E. Discussion with, and providing advice and information, including prescribing therapy to the patient
   or the patient’s representative, whether by telephone or otherwise, on matters related to:
      a. the service; and
      b. in circumstances in which it would be professionally appropriate that results can be reported
         upon prior to any further patient visit, the results of related procedure(s) and/or
         assessment(s).
F. When medically indicated, monitoring the condition of the patient and intervening, until the next
   insured service is rendered.
G. Providing premises, equipment, supplies, and personnel for the specific elements of the service.
While no occasion may arise for performing elements B, C, D and F, when performed in connection
with the other specific elements they are included in the service.

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 308 / A180

CONSULTATIONS AND VISITS
      PHYSICAL MEDICINE & REHABILITATION (31)
                 Team management in a Rehabilitation Unit
                  Team management in a Rehabilitation Unit active in-patient rehabilitation management from
                  the initiation of rehabilitation care as it applies to fee codes H312, H317 and H319 means when
                  this service is rendered by one physiatrist even if part of the service is rendered in an active
                  treatment hospital and part is rendered in a rehabilitation unit, the weekly and monthly
                  limitations under the following fee codes apply to the total rehabilitation care rendered. In other
                  words, it is not possible to claim the maximum fees allowed under C312, C317 and C319 and
                  then start claiming de novo under H312, H317 and H319 under the above circumstances.
               H312 - first twelve weeks ................................................... per visit        50.15
               H317 - from thirteenth to twenty-sixth week (maximum 3 per patient
                        per week)................................................................ per visit   50.15
               H319 - twenty-seventh week onwards (maximum 6 per patient per
                        month) .................................................................... per visit 50.15
                 Rehabilitation counselling
                  Rehabilitation counselling one or more persons. Unit means ½ hour or major part thereof - see
                  General Preamble GP7, GP55 for definitions and time-keeping requirements.
               H313 Rehabilitation counselling ........................................... per unit 84.20
                 Physiatric management
                   Physiatric management is the service rendered by physiatrists for regulation, management and
                   supervision of the active, regular, and ongoing treatment of a patient in a rehabilitation
                   department by physical or other (e.g. occupational, speech) therapists. The service also
                   includes making arrangements for any related assessments, procedures or therapy and
                   making arrangements for follow-up care as required.
               K313 Physiatric management .......................................................... 8.10
                   Payment rules:
                   1.Physiatric management is not eligible for payment if any other service is rendered by the
                     same physician on the same day to the same patient.
                                          2.This service is only eligible for payment on days when rehabilitation services are provided to
                                            patients seen previously by the physiatrist for consultation or assessment.

Master, record 2458. Record Layout PDF, page 1.

H31320250401999999990000000000000000000000000008420000000000000000000000000

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.