K119

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.

PDF page 299 / A171

CONSULTATIONS AND VISITS
 PAEDIATRICS (26)
     4.K119 is only eligible for payment if the physician has rendered a minimum of three
       consultations or assessments or visits to the patient in the immediately preceding 12 month
       period.
     5.K119 is only eligible for payment to a specialist in Paediatrics (26).
     Medical record requirements:
     K119 is only eligible for payment if a standardized developmental screening tool has been
     completed three times for the previous 12 month period and is maintained in the patient’s
     permanent medical record.
          Claims submission instructions:
          Claims for K119 should only be submitted when the required elements of the service have been
          completed for the previous 12 month period.

Master, record 2961. Record Layout PDF, page 1.

K11920260401999999990000000000000000000000000014250000000000000000000000000

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.