K143

PDF page 150 / A22

CONSULTATIONS AND VISITS
      FAMILY PRACTICE & PRACTICE IN GENERAL (00)
                                  Chronic disease shared appointment
                                  Definition /Required elements of service:
                                   Chronic disease shared appointment is a pre-scheduled primary care service rendered for
                                   chronic disease management, to two or more patients with the same diagnosis of one of the
                                   diseases listed below, that consists of assessment and the provision of advice and information
                                   in respect of diagnosis, treatment, health maintenance and prevention.
                                          Each patient must have an established diagnosis of one of the following chronic diseases:
                                                 a. Diabetes
                                                  b. Congestive Heart Failure
                                                  c. Asthma
                                                  d. Chronic obstructive pulmonary disease (COPD)
                                                  e. Hypercholesterolemia
                                                   f. Fibromyalgia
                                          The physician must be in constant personal attendance for the duration of the appointment
                                          session, although another appropriately qualified health professional may lead parts of the
                                          educational component of the session (for example, a diabetic educator or nurse). In addition,
                                          a clinically appropriate assessment must be rendered to each patient by the same physician as
                                          a component of the chronic disease shared appointment.
                                          This service has the same specific elements as an assessment.
                                          [Commentary:
                                           A clinically appropriate assessment may include a brief history or examination of the affected
                                          part or region or related mental or emotional disorder.]
                   Chronic disease shared appointment - per patient - maximum 8 units per patient per day
               K140 - 2 patients................................................................ per unit 40.05
               K141 - 3 patients................................................................ per unit 26.65
               K142 - 4 patients................................................................ per unit 20.15
               K143 - 5 patients................................................................ per unit 16.60
               K144 - 6 to 12 patients....................................................... per unit    14.10
                   [Commentary:
                   A claim must be submitted for each patient receiving a service. For example, if three patients
                   are seen in a shared appointment, K141 is submitted for each patient. If four patients are seen,
                   K142 is submitted for each patient.]
                                          Payment rules:
                                          1.Unit means ½ hour or major part thereof - see General Preamble GP7, GP54 to GP61 for
                                            definitions and time-keeping requirements.
                                          2.The service is only eligible for payment when:
                                              a.the appointment is pre-scheduled; and
                                              b.each patient regularly visits the physician or another physician in the same physician
                                                group for management of their chronic disease.
                                          3.Chronic disease shared appointment rendered the same day as an additional assessment by
                                            the same physician to the same patient is not eligible for payment unless there are clearly
                                            defined different diagnoses for the two services.

Master, record 2975. Record Layout PDF, page 1.

K14320260401999999990000016600000000000000000000000000000000000000000000000

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.