K035

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 187 / A59

CONSULTATIONS AND VISITS
 FAMILY PRACTICE & PRACTICE IN GENERAL (00)
          Note:
          1.K070 is limited to one per Ontario Health atHome home care program admission per patient.
          2.K070 is not eligible for payment if the patient is currently receiving Ontario Health atHome
            home care.
     Home care supervision
       The service rendered by a physician for personally providing medical advice, direction or
       information to health care staff of a Ontario Health atHome or an Ontario Health atHome
       contractor on behalf of a patient for whom the physician provides on-going medical care. The
       date, medical advice, direction or information provided must be recorded in the patient’s
       medical record. If the information is provided verbally to staff, the name of the staff person must
       be recorded. The amount payable for home care supervision without the required record of
       service in the patient’s medical record is nil. The amount payable for home care supervision
       rendered on the same day as a consultation or visit by the same physician with the same
       patient is nil.
   K071 Acute home care supervision (first 8 weeks following
             admission to Ontario Health atHome home care program)                         21.95
   K072 Chronic home care supervision (after the 8th week following
             admission to Ontario Health atHome home care program)                         21.95
       Payment rules:
       1.K071 is limited to a maximum of one service per patient per physician per week for 8 weeks
         following admission to Ontario Health atHome home care program.
          2.K071 is limited to a maximum of two services per patient per week for 8 weeks.
          3.K072 is limited to a maximum of 2 services per month per patient per physician after the 8th
            week following admission to Ontario Health atHome home care program.
          4.K072 is limited to a maximum of four services per patient per month.
     Mandatory reporting of medical condition to the Ontario Ministry of Transportation (MTO)
       Mandatory reporting of medical condition to the Ontario Ministry of Transportation (MTO)
       requires providing to MTO information that satisfies the requirements of the Highway Traffic Act
       or any applicable regulations, and includes providing any additional information to MTO
       regarding a previous report related to the same medical condition.
   K035 Mandatory reporting of medical condition to the Ontario
            Ministry of Transportation ................................................... 36.25
       Claims submission instructions:
       Claims in excess of one per 12 month period by the same physician for the same patient should
       be submitted using the manual review indicator and accompanied by supporting
       documentation.

Master, record 2913. Record Layout PDF, page 1.

K03520250401999999990000036250000000000000000000000000000000000000000000000

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.