K014

PDF page 42 / GP28

FIRST VISIT BY PRIMARY CARE PHYSICIAN AFTER HOSPITAL DISCHARGE
  E080 First visit after hospital discharge premium, to other service
          listed in payment rule 5 below ..................................... add        25.90
      Payment rules:
      1.Subject to payment rules 2 through 5, E080 is only eligible for payment for a visit with the
        patient's primary care physician in the physician’s office or the patient’s home within two
        weeks of discharge following in-patient admission to an acute care hospital.
      [Commentary:
      This premium is not payable for visits rendered to patients in locations other than the
      physician's office or patient's home. As such, the premium is not payable for services rendered
      in places such as Nursing Homes, Homes for the Aged, chronic care hospitals, etc.]
      2.E080 is not eligible for payment if the admission to hospital was for the purpose of obstetrical
        delivery unless the mother required admission to an ICU during the hospital stay.
      3.E080 is not eligible for payment if the admission to hospital was for the purpose of newborn
        care unless the infant required admission to a NICU during the hospital stay.
      4.E080 is not eligible for payment if the admission to hospital was for the purpose of performing
        day surgery.
      5.E080 is only eligible for payment when rendered with the following services:
        A001, A003, A004, A007, A008, A261, A262, A263, A264, A888, A900, K004–K008, K013,
        K014, K022, K023, K028-K030, K032, K033, K037, K623, P003, P004, P008.

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 149 / A21

CONSULTATIONS AND VISITS
 FAMILY PRACTICE & PRACTICE IN GENERAL (00)
     Primary mental health care
       Primary mental health care is not to be billed in conjunction with other consultations and visits
       rendered by a physician during the same patient visit unless there are clearly different
       diagnoses for the two services. Unit means ½ hour or major part thereof - see General
       Preamble GP7, GP54 to GP61 for definitions and time-keeping requirements.
   K005 Individual care............................................................. per unit 80.00
        Counselling
         Unit means ½ hour or major part thereof - see General Preamble GP7, GP54 to GP61 for
         definitions and time-keeping requirements.
       Individual care
   K013 - first three units of K013 and K040 combined per patient per
            provider per 12 month period ................................. per unit                     80.00
   K033 - additional units per patient per provider per 12 month period
             ............................................................................... per unit   56.30
       Group counselling - 2 or more persons
   K040 - where no group members have received more than 3 units
           of any counselling paid under codes K013 and K040
           combined per provider per 12 month period .......... per unit                                80.00
   K041        - additional units where any group member has received 3 or
                 more units of any counselling paid under codes K013 and
                 K040 combined per provider per 12 month period . per unit                              57.30
   K014 Counselling for transplant recipients, donors or families of
          recipients and donors
           - 1 or more persons ............................................... per unit                 80.00
   K015 Counselling of relatives - on behalf of catastrophically or
          terminally ill patient
           - 1 or more persons ............................................... per unit                 80.00

Master, record 2892. Record Layout PDF, page 1.

K01420260401999999990000080000000000000000000000000000000000000000000000000

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.