W010

PDF page 66 / GP52

Payment rules:
  1. Except as outlined in payment rule #8, this service is only eligible for payment once per patient
     per calendar month.
  2. This service is only eligible for payment to the MRP.
  3. When W010 is rendered, none of the services listed as a component of W010 and rendered to
     the patient by any physician during the month are eligible for payment.
  4. In the temporary absence of the patient’s MRP (e.g. while that physician is on vacation), W010
     remains payable to the patient’s MRP if the service is performed by another physician.
  5. In the event the MRP renders one "W" prefix assessment in a calendar month and the same
     physician has rendered W010 to that patient within the previous 11-month period, only that "W"
     prefix assessment in that month is eligible for payment.
  6. In the event the MRP renders two, three or four “W” prefix assessments in a calendar month
     and the same physician has rendered W010 to that patient within the previous 11-month period,
     only W010 is eligible for payment.
  7. In the event the MRP renders more than four “W” prefix assessments to the same patient in a
     month and the same physician has rendered W010 to that patient within the previous 11-month
     period, any subsequent visits for intercurrent illness rendered by the MRP to the same patient in
     excess of four in a month are payable as W121 in addition to payment of W010.
  8. Despite the definition set out above, the requirements of W010 are met when less than two "W"
     prefix assessments were rendered during the month and/or when the patient was not in the
     institution for a full calendar month if:
      a. a patient was newly admitted to the institution and an admission assessment was rendered;
         or
      b. in the event of the death of a patient while in the institution or within 48 hours of transfer to
         hospital.
  9. Age related premiums otherwise applicable to any component service of W010 are not eligible
     for payment in addition to W010.

PDF page 66 / GP52

Claims submission instructions:
  1. Claims for W010 may be submitted when the minimum required elements of the service have
     been rendered for the month.
      [Commentary:
         a.Payment for W010 is for management of the patient for the entire month for all the
           services listed as components of the W010 service, regardless of when the claim for
           W010 is submitted.
          b.When claiming W010, do not also submit claims for "W" prefix services listed as
            components of the W010 for the same month.]
  2. The admission date of the patient must be provided on the claim for W010 or the service is not
     eligible for payment.
      a. Submit claims for W121 which meet the requirements outlined in payment rule #7 using the
         manual review indicator.

PDF page 148 / A20

CONSULTATIONS AND VISITS
FAMILY PRACTICE & PRACTICE IN GENERAL (00)
     Payment rules:
     1.In addition to satisfying all of the elements and payment rules of subsequent visit by the MRP
       – day of discharge (see page GP45), W124 is only eligible for payment under the following
       conditions:
        a.the discharge summary must include follow up required,
        b.the patient has been admitted to chronic care or convalescent hospital or nursing home
          or home for the aged for a minimum of 30 consecutive days, and
        c.the patient is discharged to another facility or to home where the ongoing care is
          expected to be assumed by a different provider.
     2.W124 is not eligible for payment for a patient admitted for respite care.
    Monthly Management of a Nursing Home or Home for the Aged Patient
 W010 Monthly management fee (per patient per month) (see
        General Preamble GP51 to GP52) .....................................          135.30

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 250 / A122

Subsequent visits (see General Preamble GP49)
                  Chronic care or convalescent hospital
               W072 - first 4 subsequent visits per patient per month....... per visit                                          40.05
               W071 - additional subsequent visits (maximum of 6 per patient per
                       month) .................................................................... per visit                    40.05
               W982 - palliative care (see General Preamble GP50)........ per visit                                             40.05
                  Nursing home or home for the aged
               W073 - first 2 subsequent visits per patient per month....... per visit                                          40.05
               W078 - subsequent visits per month (maximum of 3 per patient per
                       month) .................................................................... per visit                    40.05
               W972 - palliative care (see General Preamble GP50)........ per visit                                             40.05
               W121 Additional visits due to intercurrent illness (see General
                      Preamble GP49) .................................................... per visit                             40.05
               W124 Subsequent visit – day of discharge (see A20 for terms and
                      conditions).............................................................. per visit                       71.80
                  Monthly Management of a Nursing Home or Home for the Aged Patient
               W010 Monthly management fee (per patient per month) (see General
                      Preamble GP51 to GP52) ...................................................                              135.30

PDF page 516 / J102

[Commentary:
       1.Services not excluded in payment rule #2 such as assessments, subsequent visit fees,
         W010, K023, special visit premiums etc. remain eligible for payment when rendered with
         G512.
       2.See the Definitions section of the General Preamble for the definition of palliative care
       3.This service is eligible for payment for services rendered to patients receiving palliative care
         in any location including their home, hospital, nursing home etc.]

Master, record 6266. Record Layout PDF, page 1.

W01020260401999999990000135300000000000000000000000000000000000000000000000

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.