Physician Payment and Policy Ontario Health Insurance Program
Resource Manual for Physicians
 
2.2   General Preamble (Continued)

  • Obtaining and reviewing information (including taking history) to make the appropriate decisions to perform elements of the service
  • Obtaining consents or delivering written consents
  • Keeping and maintaining appropriate physician records
  • Providing any medical prescriptions, including associated in-person, telephone or other electronic communications, except where the request for this service is initiated by the patient and an accompanying insured service is not provided (e.g., if a patient calls and requests a prescription renewal by phone, you may provide a renewal with or without charge to the patient) 
  • Providing or submitting documents, records or information to other professionals associated with the health and development of the patient, or to the Ministry of Health and Long-Term Care for use in programs. While no charge may be made for forms required by the ministry, there are a few exceptions where a fee code is assigned, such as the Hepatitis C form (K026, K027) and the home care referral form (K070).
  • Providing premises, equipment, supplies and personnel for the service
Assessments and Consultations

 

  • For all services that are described as assessments, or as including assessments, the following is a list of specific elements, in addition to the common elements:
  • Direct physical encounter with the patient including any appropriate physical examination and ongoing monitoring of the patient’s condition where indicated. These services cannot be delegated.
  • Other inquiry, including patient history, carried out in order to arrive at any opinion as to the nature of the patient’s condition, appropriate procedures, related services and/or follow-up care which may be required
  • Making arrangements for appropriate follow-up care
  • Providing advice and information as to the results of procedures and/or related assessments that may have been arranged. This assumes that the results can be reported upon prior to any further patient visits. For example, it would not normally be necessary to schedule a second visit with a patient to review the results from a diagnostic test such as a throat swab. However, if an examination such as an exercise stress test was ordered in the first appointment, then it may be necessary to have the patient return for a second appointment to discuss the results and the second appointment would accordingly be an insured service for which a claim could be submitted.

Annual limits may apply to various codes, including individual consultation and assessment codes. 

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