Dermatology Consultation in a DHCS Designated Long Term Care Facility

This is payable only to Dermatology Specialists. It is applicable to claims for elective consultative services requested by a staff General Practitioner or Nurse Practitioner on behalf of a patient with a complex dermatological problem. The service is rendered to a resident of a DHCS Designated Long Term Care Facility in that facility. DHCS Designated Long Term Care Facilities are listed in Appendix C of this Preamble. The facility number must be entered on the claim. The service should be documented on the resident’s chart.

Special visit premiums do not apply to elective consultations. Emergency consultations and special visits must be billed using appropriate consultation, visit and premium fee codes.

High Risk Perinatal Consultation by Maternal-Fetal Medicine Specialist: A high risk prenatal consultation is a consultation by a maternal-fetal medicine specialist requiring a minimum of 40 minutes of 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. 

The service is eligible for payment only if start and stop times of the service are recorded in the patient’s permanent medical record.

A regular consult would still apply in cases where:

1. in cases where the condition does not pose a significant risk for pregnancy (for example, the patient is referred for hypothyroidism, but upon seeing the patient she is no longer hypothyroid or is well controlled on meds.) 

OR 

2. the maternal-fetal medicine specialist spends less than 40 minutes in contact with the patient. This may occur where the significant risk does not require 40 minutes for the consult (for example, a woman referred for advanced maternal age and who has no other complications would not usually require a 40 minute consult.)

According to MCP policy, eligibility for billing consultations is restricted to those General Practitioners belonging to one or more of the following categories:

a) those having additional expertise, obtained via formal training; 

b) those asked, in the absence of an appropriate specialist, to see a patient whose illness is so severe and/or complex that assessment by a second physician is deemed medically necessary;

c) those practising full time in a specialty where the consultation is in reference to a medical problem appropriate to that specialty; 

d) those who receive a referral from a specialist requesting family practice expertise; 

e) Palliative Care Unit physicians asked to assess patients’ suitability for admission to the PCU; 

f) Miller Centre Physicians asked to assess patients’ suitability for admission to the Rehabilitation Unit. 

g) those licensed to prescribe methadone for opioid dependence.