Chronic and Convalescent Care

The physician shall be remunerated for this care on a per visit basis with a maximum of one visit every five days. If the patient is seen for the first time on admission, a general or specific assessment may apply in addition to the above fees. In acute illnesses requiring special visits, premiums also apply in addition to fees allowable under the above formula.

Complex Assessment

A Complex Assessment is payable to physicians when they are providing dedicated On-Site Emergency Department Coverage at designated hospital facilities . The following services qualify for claiming a Complex Assessment:

 (a) Evaluation of a new or existing medical condition that necessitates a detailed medical history, review of previous medical records and necessary physical examination of three or more organ systems. It may include a review of diagnostic tests and the initiation of appropriate therapy/treatment. For the purposes of claiming this code the organ systems are defined as: cardiovascular, respiratory, digestive, genitourinary, musculoskeletal, hemolymphatic, integumentary, nervous, ears-nose-throat, ophthalmic and mental. 

OR 

(b) Prolonged observation and/or continuous therapy and multiple reassessments (not including discharge assessment) of patients whose illness requires it. Please note that payment for the discharge assessment is included in the complex assessment fee and is not billable in addition. 

OR

 (c) Management of patients presenting with life or limb threatening illness or injury that requires immediate evaluation and/or intervention and/or emergent treatment by the physician.

Chronic Disease Management 

Chronic Disease Management can be claimed when a family physician sees a patient under the age of 75 years, in the office setting, for a minimum of 15 minutes where the principle reason for the visit is management of one or more documented chronic conditions that require complex care. Other conditions may be dealt with during the same encounter but no other visit fee can be claimed.

The patient record for Chronic Disease Management must include the actual start and end times for the encounter. The patient record must also meet the minimum documentation requirements for visits as described previously in this General Preamble.

Chronic Diseases - Chronic Obstructive Lung Disease

Applicable Diagnosis Codes - 491, 492, 493, 494, 495, 496

Cancer - 140, 141, 142, 143, 144, 145, 146, 147, 148, 149, 150, 151, 152, 153, 154, 155, 156, 157, 158, 159, 160, 161, 162, 163, 164, 165, 170, 171, 172, 173, 174, 175, 179, 180, 181, 182, 183, 184, 185, 186, 187, 188, 189, 190, 191, 192, 193, 194, 195, 196, 197, 198, 199, 200, 201, 202, 203, 204, 205, 206, 207, 208