K133

PDF page 136 / A8

Definition/Required elements of service:
      A periodic health visit for adults with IDD is a service performed on an adult with IDD that
      consists of an intermediate assessment, appropriate history, physical examination, health
      screening and relevant counselling, and a coordinated care and management plan consistent
      with the current Canadian consensus guidelines on the primary care of adults with IDD.
       The service must include:
      a. Evaluation for and identification of any need for special accommodations in clinical settings
         as well as other health care access issues,
      b. Proactive review of the patient’s genetic and psychosocial risks,
      c. Review of any chronic diseases,
      d. Review of systems,
      e. An in-person physical examination that includes, at a minimum:
          i.   Measurement of vital signs including weight or waist circumference,
          ii. Screening for abnormalities in hearing, vision, and dentition,
          iii. Screening examination of musculoskeletal and neurological systems,
          iv. Survey examination of skin,
          v.   Detailed examination of any part(s), region(s) or system(s) needed to make a diagnosis,
               and/or rule out disease as a contributing factor
      f. Documentation of a coordinated care and management plan,
      g. Written communication of the care and management plan to the patient and their guardian,
         legal representative or other caregiver
 K133 Periodic health visit for adults with Intellectual and
        Developmental Disabilities (IDD)........................................                  164.25

PDF page 137 / A9

CONSULTATIONS AND VISITS
      FAMILY PRACTICE & PRACTICE IN GENERAL (00)
                                          Payment rules:
                                          1.K133 is limited to one per patient per 12 month period.
                                          2.Only one of K133, K131, or K132 is eligible for payment per patient per physician per 12
                                            month period.
                                          3.This service can be provided over multiple distinct time periods, however, a minimum of 50
                                            minutes total time spent in direct contact with the patient is required, exclusive of time spent
                                            rendering any other separately billable intervention to the patient. Start and stop times must
                                            be recorded for each time period related to the service. For payment purposes, the service
                                            date on the claim must be the date on which all requirements for the service have been
                                            completed. No other services are eligible for payment for time periods used to meet the time
                                            requirements of this service.
                                          4.While some aspects of K133 may be provided virtually, a minimum of 26 minutes must be
                                            provided through direct physical encounter(s).
                                          5.K133 is only payable when the patient has one of the following conditions (listed with ministry
                                            diagnostic codes):
                                              a.Autism spectrum disorder (299)
                                              b.Intellectual disability or Fetal Alcohol Syndrome (319)
                                              c.Cerebral palsy (343)
                                              d.Spina bifida, with or without hydrocephalus, meningocele, meningomyelocele (741)
                                              e.Chromosomal anomalies such as Down’s syndrome, Fragile X syndrome, other
                                                autosomal anomalies (758)
                                          Claims submission instructions:
                                          A diagnostic code listed above that corresponds to the patient’s condition must accompany the
                                          claim for payment purposes.
                                          [Commentary:
                                          1.Guidelines relating to coordinated care and management plans can be found at: https://
                                            www.cfp.ca/content/cfp/64/4/254.full.pdf
                                          2.Unless otherwise specified in the Schedule, the calculation of time excludes (1) time devoted
                                            to any other service or procedure for which an amount is payable in addition to the periodic
                                            health visit and (2) non-patient-facing time such as such as time spent reviewing charts,
                                            imaging, or documentation, etc.]
                                   Focused practice assessment (FPA)
                                    FPA is an assessment rendered by a GP/FP physician, unless otherwise specified, with
                                    additional training and/or experience in sport medicine, allergy, pain management, sleep
                                    medicine, addiction medicine (including methadone) or care of the elderly (age 65 or older).
                                    The assessment must satisfy, at a minimum, all of the requirements of an intermediate
                                    assessment.
               A917 Sport medicine FPA ................................................................                    44.55
               A927 Allergy FPA .............................................................................              44.55
               A937 Pain management FPA...........................................................                         44.55
               A947 Sleep medicine FPA................................................................                     44.55
               A957 Addiction medicine FPA..........................................................                       44.55
               A967 Care of the elderly FPA...........................................................                     44.55

PDF page 184 / A56

CONSULTATIONS AND VISITS
FAMILY PRACTICE & PRACTICE IN GENERAL (00)
   Initial discussion with patient re: smoking cessation
     Initial discussion with patient re: smoking cessation is the service rendered to a patient who
     currently smokes tobacco by the primary care physician most responsible for their patient’s
     ongoing care, in accordance with the guidelines and subject to the conditions below.
 E079 Initial discussion with patient, to eligible services ............. add         15.95
     Payment rules:
     1.E079 is only eligible for payment when rendered in conjunction with one of the following
        services: A001, A003, A004, A005, A006, A007, A008, A905, K005, K007, K013, K017,
        K130, K131, K132, K133, P003, P004, P005, P008, W001, W002, W003, W004, W008,
        W010, W102, W104, W107, W109 or W121.
     2.E079 is limited to a maximum of one service per patient per 12 month period.
     Medical record requirements:
     The medical record for this service must document that an initial smoking cessation discussion
     has taken place, by either completion of a flow sheet or other documentation consistent with
     the most current guidelines of the “Clinical Tobacco Intervention” (CTI) program, or the service
     is not eligible for payment.
     [Commentary:
     1.Physicians may complete a flow sheet or alternatively document that an initial discussion
       consistent with the 5A's model of the CTI program has taken place.
     2.E079 is not eligible for payment for discussions related to cannabis smoking or discussions
       related to vaping, including vaping tobacco.]
   Smoking cessation follow-up visit
     Smoking cessation follow-up visit is the service rendered by a primary care physician in the 12
     months following E079 that is dedicated to a discussion of tobacco smoking cessation, in
     accordance with the guidelines and subject to the conditions below.
 K039 Smoking cessation follow-up visit ........................................... 39.25
     Payment rules:
     1.K039 is only eligible for payment when E079 is payable to the same physician in the
       preceding 12 month period.
     2.K039 is limited to a maximum of two services in the 12 months following E079.
     Medical record requirements:
     The medical record for this service must document that a follow-up visit regarding smoking
     cessation has taken place, by either completion of a flow sheet or other documentation
     consistent with the most current guidelines of the “Clinical Tobacco Intervention” (CTI)
     program, or the service is not eligible for payment.
     [Commentary:
     1.Physicians may complete a flow sheet or alternatively document that an initial discussion
       consistent with the 5A's model of the CTI program has taken place.
     2.K039 is not eligible for payment for discussions related to cannabis smoking or discussions
       related to vaping, including vaping tobacco.]

Master, record 2971. Record Layout PDF, page 1.

K13320260401999999990000164250000000000000000000000000000000000000000000000

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.