K029

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.]

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 2907. Record Layout PDF, page 1.

K02920260401999999990000080000000000000000000000000000000000000000000000000

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.