K031

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 185 / A57

CONSULTATIONS AND VISITS
 FAMILY PRACTICE & PRACTICE IN GENERAL (00)
  K018 - female.................................................................................    358.45
  K021 - male....................................................................................   282.75
     Ontario Hepatitis C Assistance Program (OHCAP)
       Certification of Medical Eligibility for OHCAP - 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 completion of the Application for OHCAP -
       Physician’s Form. When a physician submits a claim for rendering any other consultation or
       visit on the same day for which the physician submits a claim for Certification of Medical
       Eligibility for OHCAP, the Certification service is included (in addition to the common elements)
       as a specific element of the other service.
   K026 Certification of Medical Eligibility for OHCAP .........................           54.70
   K027 Certification of Medical Eligibility for OHCAP - includes only
             completion of Application for OHCAP - Physician’s Form
             without an associated consultation or visit on the same day.                  21.85
     Mandatory blood testing act - Physician report
   K031 Completion of Form 1 - Physician report in accordance with
          the Mandatory Blood Testing Act ........................................                  105.20

Master, record 2909. Record Layout PDF, page 1.

K03120260401999999990000105200000000000000000000000000000000000000000000000

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.