P003

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 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.]

PDF page 534 / K4

OBSTETRICS
PRENATAL CARE
                                                                                         Asst         Surg         Anae
P003 General assessment (major prenatal visit) ..............................                          93.85
   Antenatal preventative health assessment
    The service rendered by the most responsible physician for conducting the initial review of
    antenatal risk. The review must examine all current psychosocial, genetic and medical issues
    affecting antenatal risk and must be documented in writing in the patient’s permanent medical
    record. Maximum once per pregnancy. P005 rendered same patient same day same physician
    as any other consultation or visit except P003 and P004 is an insured service payable at nil.
P005 Antenatal preventative health assessment..............................                            55.70
P004 Minor prenatal assessment .....................................................                   44.55
   High risk prenatal assessment
    A high risk prenatal assessment is an assessment by a maternal-fetal medicine specialist
    requiring a minimum of 20 minutes in direct contact with the patient for the management of a
    documented significant maternal and/or fetal risk factor(s) where the mother and/or fetus are at
    significant risk for serious complications during the pregnancy.
P002 High risk prenatal assessment ................................................     87.25
    Medical record requirements:
    The service is eligible for payment only if start and stop times of the service are recorded in the
    patient's permanent medical record.

Master, record 3936. Record Layout PDF, page 1.

P00320260401999999990000093850000000000000000000000000000000000000000000000

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.