K022

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 178 / A50

Claims submission instructions:
     K739 is only eligible for payment if the consultant physician includes the referring physician’s or
     nurse practitioner’s provider number with the claim.
     [Commentary:
     1.Payment, other than by fee-for-service includes compensation where the physician receives
       remuneration under a salary, primary care, stipend, APP or AFP model.
     2.Physicians who receive compensation other than by fee-for-service under this Schedule
       should consult their contract for guidance on shadow-billing.]
   HIV primary care
     Primary care of patients infected with the Human Immunodeficiency Virus which includes any
     combination of common and specific elements of any insured service listed under “Family
     Practice & Practice In General” in the “Consultations and Visits” section and, in all cases,
     includes the same minimum time period requirements described for counselling in the General
     Preamble GP58. When a physician submits a claim for rendering any other consultation or visit
     to the same patient on the same day for which the physician submits a claim for HIV Primary
     Care, the HIV Primary Care service is included (in addition to the common elements) as a
     specific element of the other insured service. Unit means ½ hour or major part thereof - see
     General Preamble GP7, GP55 for definitions and time-keeping requirements.
 K022 HIV primary care......................................................... per unit 80.00

Master, record 2900. Record Layout PDF, page 1.

K02220260401999999990000080000000000000000000000000000000000000000000000000

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.