K045

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 229 / A101

CONSULTATIONS AND VISITS
 ENDOCRINOLOGY & METABOLISM (15)
     2.K046 is not eligible for payment unless the record identifies any CDE performing the
       elements of the flow sheet.
          [Commentary:
          1.In circumstances where the CDE is employed by facilities, organizations or persons other
            than the physician, such as public hospitals, public health units, ICHSCs, industrial clinics or
            long-term care facilities, K046 is not eligible for payment.
          2.For payment purposes, services rendered by the Certified Diabetic Educator (CDE) do not
            require the physical presence of a physician for direct supervision. It is required that the CDE
            performing services has the appropriate authorization from the applicable regulatory college,
            the CDE reports to the physician, and the services are rendered in accordance with accepted
            professional standards and practice.
          3.K046 is payable in addition to K045.]
          Claims submission instructions:
          Claims for K046 may only be submitted when the required elements of the service have been
          completed for the previous 12 month period.

PDF page 257 / A129

CONSULTATIONS AND VISITS
      INTERNAL MEDICINE (13)
                 GENERAL LISTINGS
               A135 Consultation............................................................................               192.85
                 Comprehensive internal medicine consultation
                   This service is a consultation rendered by a specialist in internal medicine who provides all the
                   appropriate elements of a consultation and spends a minimum of seventy-five (75) minutes of
                   direct contact with the patient exclusive of time spent rendering any other separately billable
                   intervention to the patient.
               A130 Comprehensive internal medicine consultation ......................           342.25
                   Medical record requirements:
                   The start and stop times must be recorded in the patient’s permanent medical record or the
                   amount payable for the service will be adjusted to a lesser paying fee.
                                          [Commentary:
                                          1.A130 must satisfy all the elements of a consultation (see page GP16).
                                          2.Unless otherwise specified in the Schedule, the calculation time for comprehensive internal
                                            medicine consultations excludes (1) time devoted to any other service or procedure for which
                                            an amount is payable in addition to the consultation and (2) non-patient-facing time such as
                                            such as time spent reviewing charts, imaging, or documentation, etc.]
               A435 Limited consultation ................................................................                  123.10
               A136 Repeat consultation ................................................................                   123.10
               A133 Medical specific assessment ..................................................                          95.95
               A134 Medical specific re-assessment..............................................                            72.00
               A131 Complex medical specific re-assessment...............................                                   83.40
               A138 Partial assessment .................................................................                    44.75
               A120 Colonoscopy assessment, same day as colonoscopy ...........                        18.85
                   Note:
                   1.A120 is the only assessment service eligible for payment on the same day as a colonoscopy
                     if a major pre-operative visit has been rendered by any physician in the 12 month period prior
                     to the date of the colonoscopy service.
                   2.A120 is not eligible for payment if a major pre-operative visit is eligible for payment on the
                     same day as colonoscopy.
                   3.A120 is only eligible for payment to physicians in the following specialties: Internal Medicine
                     (13) and Gastroenterology (41).
                                          [Commentary:
                                          For the definition of major pre-operative visit, see the definition page GP4.]
               K045 Diabetes management by a specialist ....................................     80.25
               K046 Diabetes team management................................................... 127.20
                   [Commentary:
                   For K045 and K046 definition/required elements, payment rules and record keeping
                   requirements see Endocrinology and Metabolism section.]

PDF page 298 / A170

CONSULTATIONS AND VISITS
      PAEDIATRICS (26)
                                  Prenatal consultation
                                   A prenatal consultation is the service rendered by a paediatrician upon request of a physician
                                   or nurse practitioner who considers a fetus of greater than 20 weeks gestation to be at risk or in
                                   jeopardy by reason of continuation of pregnancy in the presence of maternal and/or fetal
                                   distress.
                   [Commentary:
                   A prenatal consultation by a paediatrician does not preclude the paediatrician from claiming a
                   post-natal consultation on the infant.]
               A665 Prenatal consultation ..............................................................  105.50
               A565 Limited consultation ................................................................ 104.70
               A266 Repeat consultation ................................................................  104.70
               A263 Medical specific assessment ..................................................                                     95.75
               A264 Medical specific re-assessment..............................................                                       70.75
               A661 Complex medical specific re-assessment...............................                                              86.35
               A268 Enhanced 18 month well baby visit (see General Preamble
                      GP34) .................................................................................                          74.25
               A261 Level 1 - Paediatric assessment.............................................                                       24.85
               A262 Level 2 - Paediatric assessment.............................................                                       50.20
               E078                           - chronic disease assessment premium (see General
                                                Preamble GP25) ................................................ add 50%
               K045 Diabetes management by a specialist ....................................   80.25
                   [Commentary:
                   For K045 definition/required elements, payment rules, and record keeping requirements, see
                   Endocrinology and Metabolism section.]
                 Periodic health visit
               K267 - 2 - 11 years of age.............................................................. 48.05
               K269 - 12 - 17 years of age ...........................................................  89.15
                   Note:
                   1.For definitions and payment rules - see General Preamble GP21.
                   2.Diagnostic interview and/or counselling with child and/or parent - see listings in Family
                     Practice & Practice in General.
                 Paediatric Developmental Assessment Incentive (PDAI)
                   PDAI is the service rendered by a paediatrician most responsible for providing ongoing
                   management of a paediatric patient at developmental risk. The service is for ongoing
                   management using a developmental surveillance approach and documenting the indicators of
                   the child’s development three times in a 12 month period.
               K119 Paediatric developmental assessment incentive ....................          142.50
                   Payment rules:
                   1.K119 is limited to a maximum of one service per patient per 12 month period.
                                          2.K119 is limited to a maximum of six services per patient per lifetime.
                                          3.K119 is only eligible for payment for a service rendered to a person under six years of age.

Master, record 2922. Record Layout PDF, page 1.

K04520260401999999990000000000000000000000000008025000000000000000000000000

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.