W107

PDF page 65 / GP51

Definition/Required Elements of Service:
  Monthly Management of a Nursing Home or Home for the Aged Patient is the provision by the most
  responsible physician (MRP) of routine medical care, management and supervision of a patient in a
  nursing home or home for the aged for one calendar month. The service requires a minimum of two
  assessments of the patient each month, where these assessments constitute services described as
  "W" prefix assessments.
  The requirements above are subject to the exceptions as described in payment rule #8.
         [Commentary:
         As with all services described as assessments, direct physical encounter with the patient is
         required.]
  In addition to the common elements, this service includes the provision of the following services by
  any physician to the same patient during the month.
  A. Services described by subsequent visits (e.g. W003, W008).
  B. Services described by additional visits due to “intercurrent illness” (W121) except if the conditions
     described in Payment rule #7 are satisfied.
  C. Services described by palliative care subsequent visits (e.g. W872).
  D. Services described by admission assessments (e.g. W102, W104, W107).
  E. Services described by periodic health visit or general re-assessments (e.g. W109, W004).
  F. Services described by visit for pronouncement of death (W777) or certification of death (W771)
     except if the services are performed in conjunction with a special visit.
  G. Service described by anticoagulation supervision (G271).
  H. Completion of home care referral form and home care supervision (K070, K071, K072).
  I. Services described by the following diagnostic and therapeutic procedures – venipuncture (G489),
     injection (G372, G373), immunization (G538, G590, G849), collection of cervical cancer screening
     specimen(s) (G365, G394, E430, E431), intravenous (G379), and laboratory test codes (G001,
     G002, G481, G004, G005, G009, G010, G011, G012, G014).
  J. All medication reviews.
  K. All discussions with the staff of the institution related to the patient’s care.
  L. All telephone calls from the staff of the institution, patient, patient’s relative(s) or patient’s
     representative in respect of the patient between the hours of 0700 hours and 1700 hours Monday
     to Friday (excluding holidays).
  M.Ontario Drug Benefit Limited Use prescriptions/forms or Section 8 Ontario Drug Benefits Act
    requests.

PDF page 147 / A19

CONSULTATIONS AND VISITS
      FAMILY PRACTICE & PRACTICE IN GENERAL (00)
                                      EMERGENCY OR OUT-PATIENT DEPARTMENT (OPD)
                                       Physician in hospital but not on duty in the Emergency Department when seeing patient(s) in
                                       the Emergency or OPD - use General Listings.
                 NON-EMERGENCY LONG-TERM CARE IN-PATIENT SERVICES
                  Non-Emergency Long-Term Care In-Patient Services includes Chronic Care Hospitals,
                  Convalescent Hospitals, Nursing Homes, Homes for the Aged, designated chronic or
                  convalescent care beds in hospitals and nursing homes or homes for the aged, other than
                  patients in designated palliative care beds. For emergency calls and other special visits to in-
                  patients, use General Listings and Premiums when applicable - see General Preamble GP65
                  to GP78.
               W105 Consultation ............................................................................  95.60
               W911 Special family and general practice consultation - subject to
                       the same conditions as A911 ..............................................             164.95
               W912 Comprehensive family and general practice consultation -
                       subject to the same conditions as A912 .............................                   247.40
               W106 Repeat consultation ................................................................       45.90
                 Admission assessment
               W102 - Type 1 .................................................................................     71.20
               W104 - Type 2 .................................................................................     20.60
               W107 - Type 3 .................................................................................     30.70
               W109 Periodic health visit .................................................................        72.35
               W777 Intermediate assessment - Pronouncement of death - subject
                       to the same conditions as A777 ..........................................                   44.55
               W771 Certification of death - subject to same conditions as A771....                                24.20
               W004 General re-assessment of patient in nursing home (per the
                      Nursing Homes Act)............................................................ 38.35
                  Note:
                  W004 may be claimed 6 months after Periodic health visit (per the Nursing Homes Act).

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.]

Master, record 6310. Record Layout PDF, page 1.

W10720260401999999990000030700000000000000000000000000000000000000000000000

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.