| Common terms: |
|
|---|---|
| Category: | V Visit |
| Base rate: | $25.09 |
When providing psychotherapy and non psychotherapy services at the same encounter, only ONE claim for a visit service may be submitted for payment. Either the psychotherapy service or the visit service (03.03A, 03.03AZ, 03.03F, 03.03FZ etc.). The claim should reflect the service where the majority of the time was spent providing services. Reminder that 08.19G and 08.19GZ only include direct face-to-face time, extended time may not be claimed for indirect services.
| Type | Code | # of calls | Explicit | Action | Amount |
|---|---|---|---|---|---|
| SKLL | ANES | Replace Base | $25.63 | ||
| SKLL | ANPA | Replace Base | $43.90 | ||
| SKLL | CARD | Replace Base | $54.17 | ||
| SKLL | CLIM | Replace Base | $56.82 | ||
| SKLL | CMSP | Replace Base | $56.82 | ||
| SKLL | CRSG | Replace Base | $27.37 | ||
| SKLL | CTSG | Replace Base | $27.37 | ||
| SKLL | DERM | Replace Base | $38.75 | ||
| SKLL | DIRD | Replace Base | $37.09 | ||
| SKLL | E/M | Replace Base | $46.83 | ||
| SKLL | EMSP | Replace Base | $30.63 | ||
| SKLL | FTER | Replace Base | $30.63 | ||
| SKLL | GAST | Replace Base | $68.00 | ||
| SKLL | GNSG | Replace Base | $45.62 | ||
| SKLL | GP | Replace Base | $39.49 | ||
| SKLL | HEM | Replace Base | $56.82 | ||
| SKLL | HEPA | Replace Base | $43.90 | ||
| SKLL | IDIS | Replace Base | $50.89 | ||
| SKLL | INMD | Replace Base | $56.82 | ||
| SKLL | MDBI | Replace Base | $43.90 | ||
| SKLL | MDGN | Replace Base | $61.36 | ||
| SKLL | MDMI | Replace Base | $43.90 | ||
| SKLL | MDON | Replace Base | $56.82 | ||
| SKLL | NCMD | Replace Base | $37.09 | ||
| SKLL | NEPH | Replace Base | $79.09 | ||
| SKLL | NEUR | Replace Base | $53.98 | ||
| SKLL | NPM | Replace Base | $61.36 | ||
| SKLL | NUPA | Replace Base | $43.90 | ||
| SKLL | NUSG | Replace Base | $34.20 | ||
| SKLL | OBGY | Replace Base | $38.34 | ||
| SKLL | OCMD | Replace Base | $56.82 | ||
| SKLL | OPHT | Replace Base | $46.15 | ||
| SKLL | ORTH | Replace Base | $36.82 | ||
| SKLL | OTOL | Replace Base | $36.37 | ||
| SKLL | OVAC | Replace Base | $46.15 | ||
| SKLL | PATH | Replace Base | $43.90 | ||
| SKLL | PDGE | Replace Base | $68.00 | ||
| SKLL | PDNR | Replace Base | $61.36 | ||
| SKLL | PDSG | Replace Base | $61.36 | ||
| SKLL | PED | Replace Base | $61.36 | ||
| SKLL | PEDC | Replace Base | $61.36 | ||
| SKLL | PEDN | Replace Base | $79.09 | ||
| SKLL | PHMD | Replace Base | $60.14 | ||
| SKLL | PLAS | Replace Base | $62.28 | ||
| SKLL | PSYC | Replace Base | $39.71 | ||
| SKLL | RHEU | Replace Base | $49.71 | ||
| SKLL | ROSP | Replace Base | $39.49 | ||
| SKLL | RSMD | Replace Base | $56.44 | ||
| SKLL | THOR | Replace Base | $41.83 | ||
| SKLL | UROL | Replace Base | $52.00 | ||
| SKLL | VSSG | Replace Base | $25.09 | ||
| AGE | G75GP | Increase Base To | 120% | ||
| CARE | CMXV15 | Yes | Increase Base By | $15.74 | |
| CARE | CMXV20 | Yes | Increase Base By | $15.74 | |
| CARE | CMXV30 | Yes | Increase Base By | $31.51 | |
| CARE | CMXV35 | Yes | Increase Base By | $31.51 | |
| CMPX | CMGP | 1 - 10 | Yes | For Each Call Increase By | $19.19 |
| TELE | TELES | Yes | Increase Base To | 120% |
"Active Practice" is defined as a physician that has fulfilled both of the following criteria in the previous 12 months:
An "in office" service is defined as a service that is not provided in the following publically funded facility types: Active Treatment Centre, Ambulatory Care Centre, Auxiliary Hospital, Health Canada Nursing Station, Community Ambulatory Care Centre, Community Mental Health Clinic, Nursing Home, Regional Contracted Practitioner Office and Subacute Auxiliary Hospitals. The following Health Service Codes are designated as "in office": 03.03A, 03.03B, 03.03F, 03.04A, 03.05I, 03.07A, 03.08A, 03.08B, 03.08I, 03.08J, 08.19A, 08.19G, 08.19GA, and 08.45.
An "out of office" service is defined as a service that is provided in the following publically funded facility types: Active Treatment Centre, Ambulatory Care Centre, Auxiliary Hospital, Health Canada Nursing Station, Community Ambulatory Care Centre, Community Mental Health Clinic, Nursing Home, Regional Contracted Practitioner Office and Subacute Auxiliary Hospitals. The following Health Service Codes are designated as "out of office": 03.03AZ, 03.03BZ, 03.03FZ, 03.04AZ 03.05IZ, 03.07AZ, 03.08AZ, 03.08BZ, 03.08IZ, 03.08JZ, 08.19AZ, 08.19GZ, and 08.45Z
Limited Visit: A limited assessment, of a patient, which includes a history limited to and related to the presenting problem, and an examination which is limited to relevant body systems, an appropriate record, and advice to the patient. It includes the ordering of appropriate diagnostic tests and procedures as well as discussion with the patient.
In general, when an office visit and a hospital admission are provided to a patient on the same day by the same physician, only the greater benefit may be claimed. There are two exceptions to this. Firstly, if a new condition arose and the patient was seen at two separate encounters, both services may be claimed. Information must accompany this claim. Secondly, two services may be claimed when they fall within the provisions of GR 2.7.3.
Routine follow-up visits provided for a premature infant after 90 days and 180 days of age may each be claimed under HSC 03.03A or 03.03AZ.
Routine follow-up visits provided for a premature infant after 90 days and 180 days of age may each be claimed under HSC 03.03A, 03.03AZ or its equivalent.
Whether the baby is ill or well the first office visit of a newborn, within 14 days of the date of birth, cannot exceed the "limited" evaluation rate if the physician has received payment for care of healthy newborn in hospital (HSC 03.05G) or inpatient care. Subsequent to the initial post-partum visit, a physician may charge under whatever HSCs are appropriate for the care provided.
If a physician performs a minor procedure and provides a service warranting a claim for an office visit or a home visit on the same day, benefits for both may be claimed only if the services and diagnoses are unrelated.
If a service is provided in a hospital emergency department, AACC or UCC, only the minor procedure or the visit benefit, whichever is the greater, may be claimed, unless the problems are emergencies and the diagnoses are unrelated.
A procedure benefit includes removal of sutures. The physician who placed sutures may not claim for removing them. A second physician who is in the same practice group as the surgeon may not claim for removing the sutures either. However, a second physician may claim a visit for removal of sutures if he is not a member of the same practice group as the practitioner who put the sutures in.
Three technical services and three interpretive services from the following examinations may be claimed in addition to HSCs 03.02A, 03.03A, 03.03AZ, 03.07A, 03.07AZ, and 03.07B:
When done independently on a separate day or as a repeat, not more than three interpretations and three technical services from the list in GR 9.1.3 may be claimed.
