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After hours non-elective hospital services exempt from threshold calculation

New 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.

3.        Other Schedule Changes

3.1       Emergency Department Services

Preparation of In-patient Interim Admission Orders - H105

This 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.

Emergency and Out-patient Department Special Visit Premiums

The 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.

Emergency Department Alternative Funding Agreements

New 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.

3.2       Pediatric Medical Specific Assessment and Medical Specific Re-Assessment

The 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.

3.3       Midwife-Requested Assessment

Midwife-requested 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.

3.4       Radiation Oncology

Four 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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