K623

PDF page 42 / GP28

FIRST VISIT BY PRIMARY CARE PHYSICIAN AFTER HOSPITAL DISCHARGE
  E080 First visit after hospital discharge premium, to other service
          listed in payment rule 5 below ..................................... add        25.90
      Payment rules:
      1.Subject to payment rules 2 through 5, E080 is only eligible for payment for a visit with the
        patient's primary care physician in the physician’s office or the patient’s home within two
        weeks of discharge following in-patient admission to an acute care hospital.
      [Commentary:
      This premium is not payable for visits rendered to patients in locations other than the
      physician's office or patient's home. As such, the premium is not payable for services rendered
      in places such as Nursing Homes, Homes for the Aged, chronic care hospitals, etc.]
      2.E080 is not eligible for payment if the admission to hospital was for the purpose of obstetrical
        delivery unless the mother required admission to an ICU during the hospital stay.
      3.E080 is not eligible for payment if the admission to hospital was for the purpose of newborn
        care unless the infant required admission to a NICU during the hospital stay.
      4.E080 is not eligible for payment if the admission to hospital was for the purpose of performing
        day surgery.
      5.E080 is only eligible for payment when rendered with the following services:
        A001, A003, A004, A007, A008, A261, A262, A263, A264, A888, A900, K004–K008, K013,
        K014, K022, K023, K028-K030, K032, K033, K037, K623, P003, P004, P008.

PDF page 48 / GP34

PSYCHIATRIC ASSESSMENT UNDER THE MENTAL HEALTH ACT
Definition/Required elements of service:
A psychiatric assessment under the Mental Health Act (K620, K623, K624, and K629) includes such
psychiatric history, inquiry, and examination of the patient, as is appropriate, to enable the physician to
complete, and includes completing, the relevant forms and to notify the patient, family, patient
representative and relevant authorities under the Mental Health Act, where appropriate.

PDF page 317 / A189

CONSULTATIONS AND VISITS
 PSYCHIATRY (19)
        Assessments under the Mental Health Act
         See General Preamble GP34 for definitions and conditions.
     Consultation for involuntary psychiatric treatment
       Consultation for involuntary psychiatric treatment in accordance with the Mental Health Act.
       Unit means ½ hour or major part thereof - see General Preamble GP7, GP55 for definitions
       and time-keeping requirements.
   K620 Consultation for involuntary psychiatric treatment ...... per unit          108.35
     Form 1
       Application for psychiatric assessment, in accordance with the Mental Health Act includes
       necessary history, examination, notification of the patient, family and relevant authorities and
       completion of form.
   K623 Application for psychiatric assessment...................................      133.60
     Form 3
       Certification of involuntary admission in accordance with the Mental Health Act includes
       necessary history, examination, notification of the patient, family and relevant authorities and
       completion of form.
   K624 Certification of involuntary admission .....................................   164.50
   K629 All other re-certification(s) of involuntary admission including
            completion of appropriate forms.........................................     48.75
          Note:
          1.A completed Form 1 Application by a Physician For Psychiatric Assessment retained on the
            patient’s medical record is sufficient documentation to indicate that a consultation for
            involuntary psychiatric treatment has been requested by the referring physician.
          2.Consultations or assessments claimed in addition to certification or re-certification same day
            are payable at nil.
          3.Interviews with relatives on behalf of a patient, Children’s Aid Society (CAS) staff or legal
            guardian, etc. - see listings in Family Practice & Practice In General.
          4.Certification of incompetence (financial) including assessment to determine incompetence is
            not an insured benefit.

PDF page 481 / J67

B. Point of care drug testing
   G041 Target drug testing, urine, qualitative or quantitative .. per test             3.70
   G042 Target drug testing, urine, qualitative or quantitative .. per test             2.50
      [Commentary:
      G041 and G042 are tests for a specific drug of abuse.]
   G040 Drugs of abuse screen, urine, must include testing for at
          least four drugs of abuse........................................ per test   15.00
   G043 Drugs of abuse screen, urine, must include testing for at
          least four drugs of abuse........................................ per test    7.50
      [Commentary:
      Drugs of abuse may include any of the following: alcohol, methadone, methadone metabolite,
      morphine, a synthetic or semi-synthetic opiate, cocaine, benzodiazepines, amphetamines,
      methamphetamines, cannabinoids, barbiturates or any other drug of abuse.]
   G039 Creatinine ............................................................................... 1.03
      Payment rules:
      1. G040 and G041 are limited to a maximum of five (5) services per patient (any combination)
        per month to any physician when K682 or K683 is payable.
          2. G042 and G043 are limited to a maximum of four (4) services per patient (any combination)
            per month to any physician when K682 or K683 is payable.
          3. Any combination of G040, G041, G042 and G043 is limited to a maximum of three (3)
            services per patient per month for management of a patient with chronic pain, an addiction,
            or receiving opioid agonist treatment program where K682 or K683 is not payable in the
            month for the same patient to any physician.
          4. G040, G041, G042 and G043 are not eligible for payment unless K623 or K624 or a
            consultation, assessment or time–based service involving a direct physical encounter with
            the patient is payable in the same month to the same physician rendering the G040, G041,
            G042 or G043 service.
          5. G039 is limited to a maximum of two (2) tests per patient per week, any physician.
          6. G039 is only eligible for payment when rendered to rule out urine tampering.
          7. Only one of G040, G041, G042 or G043 is eligible for payment per urine sample.

Master, record 3021. Record Layout PDF, page 1.

K62320260401999999990000133600000000000000000000000000000000000000000000000

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.