K046

PDF page 228 / A100

Definition/Required elements of service:
    This is an annual fee payable to a specialist in internal medicine or endocrinology for the
    comprehensive team-based care of a patient with diabetes.
     The diabetes management team must include the specialist most responsible for the diabetes
     management of the patient and at least one or more Certified Diabetes Educators (CDE). DTM
     includes all services related to the coordination, provision and documentation of all required
     elements of ongoing care, as necessary, by the physician and/or the CDE.
 K046 Diabetes team management...................................................  127.20
     Payment rules:
     1.A maximum of one K046 is eligible for payment per patient per 12 month period.
     2.K046 is only eligible for payment if all of the following requirements are fulfilled:
         a.the physician has rendered a minimum of 4 of any combination of consultations/
           assessments or K013, K033, K029, K002, K003 to the same patient in the 12 month
           period for which K046 is claimed;
         b.the CDE is an employee of the physician;
         c.when the physician has treated more than 100 patients with diabetes during the period for
           which K046 is claimed; and
         d.the physician is from one of the following specialities: Internal Medicine (13) or
           Endocrinology (15).
     3.K046 is not eligible for payment unless the physician documents the services rendered by
       the CDE. The physician must provide such documentation to the ministry, if requested.
     4.The CDE must have current certification by the Canadian Diabetes Educator Certification
       Board at the time the CDE renders services to the patient.

PDF page 228 / A100

Medical record requirements:
     1.K046 is only eligible for payment when the record includes a flow sheet and/or a diabetic
       registry record meeting the published Standards of Care as defined in the Canadian Diabetes
       Association Clinical Practice Guidelines. The minimum required elements of the diabetes
       flow sheet include:
         a.Laboratory parameters including:
            i. Lipid profile (cholesterol, triglycerides);
            ii. glycosylated haemoglobin (HgbA1C);
            iii. albumin to creatinine ratio (ACR; and
            iv. estimated glomerular filtration rate (eGFR) or Creatinine Clearance (CrCl)
         b.Blood pressure;
         c.Height, weight and body mass index (BMI);
         d.Medications (including dosage);
         e.Services related to prevention of diabetic complications;
         f. Health promotion counselling and patient self-management support;
         g.Evaluation and referral, as necessary, for dilated eye examination;
         h.Foot examination; and
         i. Neurological examination

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.]

Master, record 2923. Record Layout PDF, page 1.

K04620260401999999990000000000000000000000000012720000000000000000000000000

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.