K002

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 156 / A28

CONSULTATIONS AND VISITS
FAMILY PRACTICE & PRACTICE IN GENERAL (00)
   Interviews
     Interviews are not eligible for payment when the information being obtained is part of the
     history normally included in the consultation or assessment of the patient. The interview must
     be a booked, separate appointment lasting at least 20 minutes. Unit means ½ hour or major
     part thereof - see General Preamble GP7, GP54 to GP61 for definitions and time-keeping
     requirements.
 K002 Interviews with relatives or a person who is authorized to make
          a treatment decision on behalf of the patient in accordance
          with the Health Care Consent Act .......................... per unit       80.00
     Payment rules:
     K002 is only eligible for payment if the physician can demonstrate that the purpose of the
     interview is not for the sole purpose of obtaining consent.
 K003 Interviews with Children’s Aid Society (CAS) or legal guardian
           on be half of the patient in accordance with the Health Care
           Consent Act conducted for a purpose other than to obtain
           consent................................................................... per unit       80.00
     Note:
     K002, K003 are claimed using the patient’s health number and diagnosis. These listings apply
     to situations where medically necessary information cannot be obtained from or given to the
     patient or guardian, e.g. because of illness, incompetence, etc.
 K008 Diagnostic interview and/or counselling with child and/or
           parent for psychological problem or learning disabilities
            ............................................................................... per unit 80.00
     Note:
     K008 is claimed using the child’s health number. Psychological testing is not an insured
     service.

PDF page 227 / A99

Definition/Required elements of service:
         Diabetes Management by a specialist is a service rendered by a specialist in Endocrinology,
         Internal Medicine or Paediatrics who is most responsible for providing ongoing management of
         a diabetic patient. This service includes all services related to the coordination, provision and
         documentation of ongoing management using a planned care approach consistent with the
         required elements of the current Canadian Diabetes Association (CDA) Clinical Practice
         Guidelines. The medical record must document that all of the CDA required elements have
         been provided for the previous 12 month period and include, at a minimum, the following:
             a.Lipids, cholesterol, HbA1C, blood pressure, weight and body mass index (BMI), and
                medication dosage;
             b.Discussion and offer of preventive measures including vascular protection, influenza and
                pneumococcal vaccination;
             c.Health promotion counselling and patient self-management support;
             d.Albumin to creatinine ratio (ACR);
             e.Discussion and offer of referral for dilated eye examination; and
             f. Foot examination and neurologic examination.
   K045 Diabetes management by a specialist ....................................    80.25
       Payment rules:
       1.K045 is limited to a maximum of one service per patient per 12 month period.
          2.K045 is only eligible for payment if the physician has rendered a minimum of 4 of any of the
            following: consultations/assessments, K013, K033, K029, K002, K003 to the same patient in
            the 12 month period for which K045 is claimed.
          3.K045 is only eligible for payment when the physician has greater than 100 patients per year
            with diabetes.
          4.K045 is eligible for payment to a physician from one of the following specialties: Internal
            Medicine (13), Endocrinology (15) or Paediatrics (26).
          Medical record requirements:
          K045 is only eligible for payment if the flow sheet and/or a diabetic registry record has been
          completed for the previous 12 month period including the above listed requirements and is
          maintained in the patient’s permanent medical record.
          Claims submission instructions:
          Claims for K045 may only be submitted when the required elements of the service have been
          completed for the previous 12 month period.
          [Commentary:
          A copy of a flow sheet meeting the medical record requirements and CDA Clinical Practice
          Guidelines may be found at https://guidelines.diabetes.ca/GuideLines/media/Docs/cpg/
          Appendix-3.pdf ]

PDF page 228 / A100

Definition/Required elements of service:
    This is an annual fee payable to a specialist in internal medicine or endocrinology for the
    comprehensive team-based care of a patient with diabetes.
     The diabetes management team must include the specialist most responsible for the diabetes
     management of the patient and at least one or more Certified Diabetes Educators (CDE). DTM
     includes all services related to the coordination, provision and documentation of all required
     elements of ongoing care, as necessary, by the physician and/or the CDE.
 K046 Diabetes team management...................................................  127.20
     Payment rules:
     1.A maximum of one K046 is eligible for payment per patient per 12 month period.
     2.K046 is only eligible for payment if all of the following requirements are fulfilled:
         a.the physician has rendered a minimum of 4 of any combination of consultations/
           assessments or K013, K033, K029, K002, K003 to the same patient in the 12 month
           period for which K046 is claimed;
         b.the CDE is an employee of the physician;
         c.when the physician has treated more than 100 patients with diabetes during the period for
           which K046 is claimed; and
         d.the physician is from one of the following specialities: Internal Medicine (13) or
           Endocrinology (15).
     3.K046 is not eligible for payment unless the physician documents the services rendered by
       the CDE. The physician must provide such documentation to the ministry, if requested.
     4.The CDE must have current certification by the Canadian Diabetes Educator Certification
       Board at the time the CDE renders services to the patient.

Master, record 2881. Record Layout PDF, page 1.

K00220260401999999990000080000000000000000000000000000000000000000000000000

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.