K072

PDF page 65 / GP51

Definition/Required Elements of Service:
  Monthly Management of a Nursing Home or Home for the Aged Patient is the provision by the most
  responsible physician (MRP) of routine medical care, management and supervision of a patient in a
  nursing home or home for the aged for one calendar month. The service requires a minimum of two
  assessments of the patient each month, where these assessments constitute services described as
  "W" prefix assessments.
  The requirements above are subject to the exceptions as described in payment rule #8.
         [Commentary:
         As with all services described as assessments, direct physical encounter with the patient is
         required.]
  In addition to the common elements, this service includes the provision of the following services by
  any physician to the same patient during the month.
  A. Services described by subsequent visits (e.g. W003, W008).
  B. Services described by additional visits due to “intercurrent illness” (W121) except if the conditions
     described in Payment rule #7 are satisfied.
  C. Services described by palliative care subsequent visits (e.g. W872).
  D. Services described by admission assessments (e.g. W102, W104, W107).
  E. Services described by periodic health visit or general re-assessments (e.g. W109, W004).
  F. Services described by visit for pronouncement of death (W777) or certification of death (W771)
     except if the services are performed in conjunction with a special visit.
  G. Service described by anticoagulation supervision (G271).
  H. Completion of home care referral form and home care supervision (K070, K071, K072).
  I. Services described by the following diagnostic and therapeutic procedures – venipuncture (G489),
     injection (G372, G373), immunization (G538, G590, G849), collection of cervical cancer screening
     specimen(s) (G365, G394, E430, E431), intravenous (G379), and laboratory test codes (G001,
     G002, G481, G004, G005, G009, G010, G011, G012, G014).
  J. All medication reviews.
  K. All discussions with the staff of the institution related to the patient’s care.
  L. All telephone calls from the staff of the institution, patient, patient’s relative(s) or patient’s
     representative in respect of the patient between the hours of 0700 hours and 1700 hours Monday
     to Friday (excluding holidays).
  M.Ontario Drug Benefit Limited Use prescriptions/forms or Section 8 Ontario Drug Benefits Act
    requests.

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.

PDF page 515 / J101

Payment rules:
          1. This service is limited to a maximum of two services per week.
          2. This service is not eligible for payment if rendered the same day as a consultation,
            assessment, time-based service or other visit by the same physician.
          3. This service is not eligible for payment if a claim is submitted for K071 or K072 for the same
            telephone call.
          4. This service is only eligible for payment when rendered by the physician most responsible
            for the patient’s care or by a physician substituting for this physician.

PDF page 516 / J102

Payment rules:
       1. The service is only eligible for payment when rendered by the physician most responsible for
         the patient’s care, or by a physician substituting for this physician.
       2. G511, K071 or K072 are not eligible for payment to any physician when rendered during a
         week that G512 is rendered.
       3. G512 is limited to a maximum of one per week (Monday to Sunday inclusive) per patient
         and, in the instance a patient is transferred from one most responsible physician to another,
         is only eligible for payment to the physician who rendered the service the majority of the
         week.
       4. In the event of the death of the patient or where care commences on any day of the week,
         G512 is eligible for payment even if the service was not provided for the entire week.

Master, record 2940. Record Layout PDF, page 1.

K07220260401999999990000021950000000000000000000000000000000000000000000000

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.