K028

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 180 / A52

CONSULTATIONS AND VISITS
FAMILY PRACTICE & PRACTICE IN GENERAL (00)
   Sexually transmitted infection (STI) or potential blood-borne pathogen management
     Sexually transmitted infection (STI) or potential blood-borne pathogen management is a time
     based all-inclusive service for the purpose of providing assessment and counselling to a patient
     suspected of having a STI or to a patient with a potential blood-borne pathogen (e.g. following a
     "needle-stick" injury). This service is claimed in units - unit means ½ hour or major part thereof
     - see the General Preamble GP7, GP55 for definitions and time keeping requirements.
 K028 STI management ........................................................ per unit 80.00
     Payment rules:
     1.K028 is not eligible for payment when rendered with any consultation, assessment or visit by
        the same physician on the same day.
     2.K028 is limited to a maximum of two units per patient per physician per day and four units per
       patient, per physician, per year.
   Insulin therapy support (ITS)
     ITS is a time-based all-inclusive visit fee per patient per day for the purpose of providing
     assessment, support and counselling to patients on intensive insulin therapy requiring at least 3
     injections per day or using an infusion pump. The service 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. ITS
     rendered same patient same day as any other consultation or visit by the same physician is an
     insured service payable at nil. Unit means ½ hour or major part thereof - see General Preamble
     GP7, GP55 for definitions and time-keeping requirements. Maximum 6 units per patient, per
     physician, per year.
 K029 Insulin therapy support (ITS) ...................................... per unit     80.00
     [Commentary:
     K029 may be payable for services that include training for patients on insulin who use devices
     such as glucose meters, insulin pumps and insulin pens and when rendered personally by the
     physician claiming K029.]

Master, record 2906. Record Layout PDF, page 1.

K02820260401999999990000080000000000000000000000000000000000000000000000000

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.