Bulletin

   
Bulletin Number
        2036
Date
        September 1, 2001
Direct inquiries to

         Ministry of Health
         Processing Office


(address below)
Distribution
       Independent Health Facilities
Subject     

EXPANDED HOSPITAL PRIVILEGES FOR ORAL AND MAXILLOFACIAL SURGEONS

The Ministry of Health and Long -Term Care has amended regulations under the Public Hospitals Act to allow hospitals to grant expanded admitting privileges to oral and maxillofacial surgeons.  Amendments have also been made to regulations under the Health Insurance Act to ensure that certain hospital services will be insured when a patient is admitted solely by an oral and maxillofacial surgeon. To support those expanded hospital admission privileges, oral and maxillofacial surgeons will be allowed to order specific laboratory and diagnostic tests when performed at a hospital for a hospital in-patient or out-patient where the oral and maxillofacial surgeon reasonably believes that the person will require medically necessary hospital admission for a dental surgical procedure.

 
To accommodate these inclusions, the Schedule of Benefits for Physician Services has been amended effective September 1, 2001. Oral and maxillofacial surgeons will be able to order specific diagnostic tests under Nuclear Medicine, Diagnostic Radiology, Diagnostic Ultrasound, Pulmonary Function Studies and Diagnostic and Therapeutic Procedures for their patients when performed in the hospital or in the hospital out-patient department where the oral and maxillofacial surgeon reasonably believes that the person will require medically necessary hospital admission for a dental surgical procedure.  Diagnostic services on in-patients are not paid on a fee-for-service basis but are included in the hospital’s global budget. Diagnostic services ordered by a dentist or oral and maxillofacial surgeon performed in an independent health facility, community laboratory or private physician’s office are uninsured under all circumstances.

 The specific diagnostic tests are as follows:

FEE CODES

DESCRIPTION

J850/J650 to J853/J653
Y850/Y650 to Y853/Y653
J883/J683 to J884/J684
Y883/Y683 to Y884/Y684
 

Nuclear Medicine – bone and labeled leukocyte scintigraphy

X001 to X020
X036 to X038
X066, X226
X090 to X092, X039, X400, X401, X188
X402, X405, X408
X163, X167, X176

Diagnostic Radiology – plain x-rays of the head, neck, chest, pelvis and or hip(s), tibia and fibula; 


Computed tomography of the head;
Fistulas or sinus examinations; Sialograms
 

J105/J405, J106/J406

Diagnostic Ultrasound – face and sinuses
 

J301 to J340, E450, E451, Z459

Pulmonary Function Studies
 

G310, G313

Diagnostic and Therapeutic Procedures - Electrocardiograms
 

Claims Submissions:

Any claims for services requested by an oral and maxillofacial surgeon other than those listed above will not be paid.  To ensure proper processing, the services requested by the oral and maxillofacial surgeons should be submitted separately from the other claims.

Communications

Bulletins and the updated version of the Schedule may be seen on the Ministry of Health and Long-Term Care website www.health.gov.on.ca
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