K038

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 188 / A60

Long-Term Care Health Assessment Form
     The service rendered for completion and submission of a health assessment form to Ontario
     Health atHome on behalf of a patient who is applying for admission to a Long-Term Care
     facility.
 K038 Completion of Long-Term Care health assessment form .......                 46.35
    Immediate telephone reporting - specified reportable disease to the Medical Officer of
    Health
      Telephone reporting of a specified reportable disease to a Medical Officer of Health (MOH) is
      the service of immediately providing all available information to a MOH in order to comply with
      the requirements of the Health Protection and Promotion Act and/or any applicable regulations,
      and includes providing, by any method, any subsequent information to a MOH regarding a
      previous report related to the same reported disease within the 12 month period.
 K034 Telephone reporting - specified reportable disease to a MOH                   36.00
     Payment rules:
     1.K034 is limited to a maximum of one service per physician, per patient, per specified
       reportable disease, per 12 month period.
     2.K034 is only eligible for payment when the telephone report is personally rendered by the
       physician.
     3.K034 is only eligible for payment for the following specified reportable diseases:
       anthrax, botulism, brucellosis, cholera, novel coronavirus (including SARS and MERS),
       cryptosporidiosis, cyclosporiasis, diphtheria, primary viral encephalitis, food poisoning (all
       causes), symptomatic giardiasis, invasive Haemophilus influenzae type b disease,
       Hantavirus pulmonary syndrome, hemorrhagic fevers (e.g. Ebola, Lassa, Marburg and other
       viral causes), hepatitis A, legionellosis, listeriosis, measles, acute bacterial meningitis,
       invasive meningococcal disease, paratyphoid fever, plague, acute poliomyelitis, Q fever,
       rabies, rubella, shigellosis, smallpox, invasive group A streptococcal infections, tularemia,
       typhoid fever, verotoxin-producing E. coli infection indicator conditions (e.g. haemolytic-
       uremic syndrome), and West Nile virus illness
     Medical record requirements:
     K034 is only eligible for payment if the patient record demonstrates that the required
     information of the report related to one of the specified reportable disease has been
     communicated immediately by telephone to the MOH.
     [Commentary:
     1. For payment purposes, an immediate telephone report to a MOH includes a report provided
       to a delegate of a MOH.
     2.For payment purposes, the specified list of diseases has been identified as requiring an
       immediate telephone report.]

Master, record 2916. Record Layout PDF, page 1.

K03820260401999999990000046350000000000000000000000000000000000000000000000

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.