non-elective hospital services exempt from threshold calculation
codes for special visit premiums to an out-patient department (U994, U995,
U996, U997) and for evening assessments, Monday to Friday in the Emergency
Department (H132, H133, H131, H134), and their associated services, are
exempt from threshold calculations when submitted on the same claim record
with a valid hospital number.
Emergency Department Services
of In-patient Interim Admission Orders - H105
new fee code, Preparation of In-patient Interim Admission Orders, H105, is
payable to an emergency department physician who is on-call or on-duty in
the emergency department for writing in-patient interim admission orders
pending admission of a non-elective patient by a different "most
responsible physician". The General Preamble B.6, Admission to
Hospital From the Emergency Department or Out-patient Department, is
revised to support this change. For complete information about payment
requirements, please refer to the revised General Preamble, B.5.d and B.6,
and the Consultation and Visits section of the Schedule.
and Out-patient Department Special Visit Premiums
fee codes for special visits to an out-patient department have been
separated from those for special visits to an emergency department. New
codes for special visits to an out-patient department are payable under
the same terms and conditions as they were when included with codes for
special visits to an emergency department. For complete information about
payment requirements for these codes, refer to the revised General
Preamble, B.23, and Special Visit Premiums.
Department Alternative Funding Agreements
language is added to the General Preamble, B.32, that disallows
fee-for-service payments to any physician for services that are insured
under an emergency department alternative funding agreement. For complete
information, please refer to the revised Schedule.
Pediatric Medical Specific Assessment and Medical Specific
existing fee code descriptors for pediatric General Assessment and General
Re-assessment are revised to Medical Specific Assessment and Medical
Specific Re-assessment. This change allows payment to a pediatrician for a
medical specific assessment or medical specific reassessment when that
service is required rather than a general assessment or general
re-assessment. For complete information, refer to the revised General
Preamble, Other Assessments, B.4, e, f & r and to the Consultation and
Visits section of the Schedule.
Emergency Assessment (C813) and Midwife-requested Special Emergency
Assessment (C815) were added to the Schedule of Benefits in April 1999.
Effective April 1, 2001, these codes were revised to allow payment for a
midwife-requested assessment of a newborn. Effective April 1, 2002,
C813/C815 are revised and A813/A815 are added to allow payment for
non-emergency requests. Please refer to the Consultation and Visits
section of the Schedule for complete information.
new codes are added for radiotherapy treatment planning that will be
rendered in a Cancer Care Ontario Centre or Princess Margaret Hospital to
account for the complexity and time required for this activity. Each fee
code level is tied to specific National Hospital Productivity Improvement
Project (NHPIP) Codes.
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