K030

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 181 / A53

CONSULTATIONS AND VISITS
      FAMILY PRACTICE & PRACTICE IN GENERAL (00)
                 Diabetic management assessment (DMA)
                   DMA is an all-inclusive service payable to the most responsible physician for providing
                   continuing management and support of a diabetic patient. The service must include an
                   intermediate assessment, a level 2 paediatric assessment or a partial assessment focusing on
                   diabetic target organ systems, relevant counselling and maintenance of a diabetic flow sheet
                   retained on the patient’s permanent medical record. The flow sheet must track lipids,
                   cholesterol, Hgb A1C, urinalysis, blood pressure, fundal examination, peripheral vascular
                   examination, weight and body mass index (BMI) and medication dosage. When DMA is
                   rendered to the same patient same day as any other consultation or visit by the same physician
                   or the above record is not maintained, the DMA is an insured service payable at nil. Maximum
                   4 per patient per 12 month period.
               K030 Diabetic Management Assessment .......................................         45.75
                 Diabetes management incentive (DMI)
                   DMI is a service rendered by the General/Family Physician most responsible for providing
                   ongoing management of a diabetic patient. The service consists of ongoing management using
                   a planned care approach consistent with the required elements of the Canadian Diabetes
                   Association (CDA) Clinical Practice Guidelines, documenting that all of the CDA required
                   elements have been provided for the previous 12 month period and must include
                   documentation that tracks, 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.
               Q040 Diabetes management incentive ............................................ 65.70
                  Payment rules:
                  1.Q040 is limited to a maximum of one service per patient per 12 month period.
                                          2.Q040 is only eligible for payment if the physician has rendered a minimum of three K030
                                            services for the same patient in the same 12 month period to which the Q040 service applies.
                                          Medical record requirements:
                                          A flow sheet or other documentation that records all of the required elements of the most
                                          current CDA guidelines must be included in the patient's permanent medical record, or the
                                          service is not eligible for payment.
                                          Claims submission instructions:
                                          Claims for Q040 must be submitted only 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 the following link https://guidelines.diabetes.ca/GuideLines/media/
                                          Docs/cpg/Appendix-3.pdf.]

PDF page 203 / A75

Payment rules:
          * A virtual K030 is only eligible for payment if a K030 involving a direct physical encounter has
          been performed in the preceding 12 months.

Master, record 2908. Record Layout PDF, page 1.

K03020260401999999990000045750000000000000000000000000000000000000000000000

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.