K730

PDF page 72 / GP58

COUNSELLING
  Definition/Required elements of service:
  Counselling is a patient visit dedicated solely to an educational dialogue with a physician. This service
  is rendered for the purpose of developing awareness of the patient’s problems or situation and of
  modalities for prevention and/or treatment, and to provide advice and information in respect of
  diagnosis, treatment, health maintenance and prevention.
                                          [Commentary:
                                          1.Advice given to a patient that would ordinarily constitute part of a consultation, assessment,
                                            or other treatment, is included as a common or constituent element of the other service, and
                                            does not constitute counselling.
       2.Detention time may be payable following a consultation or assessment when a physician is
         required to spend considerable extra time in treatment or monitoring of the patient. See
         GP29 for further information.]
  Payment rules:
    1. With the exception of the codes listed in the below, no other services are eligible for payment
       when rendered by the same physician the same day as any type of counselling service:
       E080, G010, G039, G040, G041, G042, G043, G202, G205, G365, G372, G384, G385, G394,
       G462, G480, G489, G482, G538, G590, G593, G840, G841, G842, G843, G844, G845, G846,
       G847, G848, G849, H313, K002, K003, K008, K014, K015, K031, K035, K036, K038, K682,
       K683, K684, K730
                    2. Individual and group counselling services are limited to 3 units per patient per physician per
                       year at the higher fee (K013 or K040 respectively); the amount payable for services rendered in
                       excess of this limit will be adjusted to a lesser fee (K033 or K041 respectively).
                    3. If the patient does not have a pre-booked appointment, the amount payable for this service will
                       be adjusted to a lesser assessment fee.
  A. Individual Counselling
  Definition:
  Individual counselling is counselling rendered to a single patient.
  B. Group Counselling
  Definition:
  Group Counselling is counselling rendered to two or more patients with a similar medical condition or
  situation.
  Payment rules:
     1. Group counselling is only eligible for payment when all of the following conditions are fulfilled:

PDF page 170 / A42

Definition/Required elements of service – Referring physician/Nurse Practitioner
     The referring physician or nurse practitioner initiates the telephone consultation with the
     intention of continuing the care, treatment and management of the patient.
     In addition to the Constituent and Common Elements of Insured Services described in the
     General Preamble of this Schedule, this service includes the transmission of relevant data to
     the consultant physician and all other services rendered by the referring physician or nurse
     practitioner to obtain the advice of the consultant physician.
       Note:
       This service is eligible for payment in addition to visits or other services provided to the same
       patient on the same day by the same referring physician.
    Definition/Required elements of service – Consultant physician
     This service includes all services rendered by the consultant physician to provide opinion/
     advice/recommendations on patient care, treatment and management to the referring
     physician. The consultant physician is required to review all relevant data provided by the
     referring physician or nurse practitioner.
 K730 Physician to physician telephone consultation - Referring
        physician .............................................................................                 37.05
 K731 Physician to physician telephone consultation - Consultant
        physician .............................................................................                 47.75

PDF page 171 / A43

CONSULTATIONS AND VISITS
 FAMILY PRACTICE & PRACTICE IN GENERAL (00)
          [Commentary:
          Referring and consultant physicians participating in physician to physician telephone
          consultations while on duty in an emergency department or a hospital urgent care clinic should
          submit claims using K734 and K735. K730 and K731 should not be claimed in these
          circumstances.]
          Payment rules:
          1.A maximum of one K730 or K734 service is eligible for payment per patient per day.
          2.A maximum of one K731 or K735 service is eligible for payment per patient per day.
          3.This service is only eligible for payment for a physician to physician telephone consultation
            service:
              a.that includes a minimum of 10 minutes of patient-related discussion for any given patient
              b.where the referring physician/nurse practitioner and consultant physician are physically
                present in Ontario at the time of the service
          4.This service is not eligible for payment to the referring or consultant physicians in the
            following circumstances:
              a.when the purpose of the telephone discussion is to arrange for transfer of the patient’s
                care to any physician;
              b.when rendered in whole or in part to arrange for a consultation, assessment, visit, or K-
                prefix time-based services, procedure(s), or diagnostic investigation(s);
              c.when rendered primarily to discuss results of diagnostic investigation(s); or
              d.when a consultant physician renders a consultation, assessment, visit, or K-prefix time-
                based service, on the same day or next day following the physician to physician
                telephone consultation for the same patient.
          5.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.

Master, record 3043. Record Layout PDF, page 1.

K73020260401999999990000037050000000000000000000000000000000000000000000000

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.