K480

PDF page 331 / A203

CONSULTATIONS AND VISITS
 RHEUMATOLOGY (48)
        Physician to allied professional telephone consultation
          This is the service where the rheumatologist participates in a telephone consultation with one or
          more of the following allied professionals who is funded by and affiliated with the Arthritis
          Society, Ontario Division:
         a. a physiotherapist who is a member of the College of Physiotherapists of Ontario;
         b. an occupational therapist who is a member of the College of Occupational Therapists of
            Ontario; or
         c. a social worker who is a member of the Ontario College of Social Workers and Social
            Service Workers.
   K480 Physician to allied professional telephone consultation..........                     31.35
          Payment rules:
          1.A maximum of one K480 service is eligible for payment per patient per day.
          2.A maximum of two K480 services are eligible for payment per patient per 12 month period.
          3.K480 is only eligible for payment for a physician to allied professional telephone consultation
            that:
              a.includes a minimum of 10 minutes of patient-related discussion; and
              b.where there is an established physician-patient relationship.
          4.K480 is not eligible for payment to the physician in the following circumstances:
              a.when the purpose of the telephone discussion is to arrange for an evaluation of the
                patient by the physician; or
              b.in circumstances where a physician receives compensation, other than by fee-for-service
                under this Schedule, for participation in the telephone consultation, this service is not
                eligible for payment to that physician.
          [Commentary:
          1.In calculating the minimum time requirement, time does not need to be continuous. In
            circumstances where a physician to allied health professional telephone consultation service
            with the consultant physician on the same day is not continuous, the total time represents the
            cumulative time of all telephone consultations with the same allied health professional on that
            day pertaining to the same patient.
          2.Payment, other than by fee-for-service includes compensation where the physician receives
            remuneration under a salary, primary care, stipend, APP or AFP model.
          3.Physicians who receive compensation other than by fee-for-service under this Schedule
            should consult their contract for guidance on shadow-billing.]
          Medical record requirements:
          K480 is only eligible for payment where the following elements are included in the medical
          record for a physician who submits a claim for the service:
          1.patient’s name and health number;
          2.start and stop times of the discussion;
          3.name(s) of the allied professional participating in the telephone consultation;
          4.reason for the consultation; and
          5.the opinion and recommendations of the physician.

Master, record 3017. Record Layout PDF, page 1.

K48020250401999999990000000000000000000000000003135000000000000000000000000

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.