Agreement Update - New fee codes, fee increases, fee revisions and deletions effective January 1, 2008

The OMA Economics Department has prepared the following notice to remind members of upcoming OHIP Schedule of Benefits changes that will take effect on January 1, 2008. 

In addition to a number of fee increases outlined in Appendix L of the Agreement, funding allocations have been made under Appendix K of the Agreement to Diagnostic Radiology, Cardiac Diagnostics, Vascular Surgery, Thoracic Surgery, General Surgery, Nuclear Medicine, Obstetrics and Gynecology, Ophthalmology, Paediatrics, Physical Medicine, and Plastic Surgery under this process. It is recommended that physicians practicing in these areas carefully review the Schedule for changes that may affect them.

A complete list of all the OHIP Schedule of Benefits changes are outlined in a document entitled “Update for All Physicians, January 1, 2008” which is posted in the OMA Agreement Tracker located in the OMA’s Economics Web Page (https://www.oma.org/members/economics/tracking.asp).

G512 Weekly palliative care case management ($51.70)

A new fee for providing supervision of palliative care to a patient for a period of one week (commencing at midnight Sunday) is scheduled to be introduced effective January 1, 2008 at a fee of $51.70.

The new fee is payable to the most responsible physician for the patient’s care for:

1. Monitoring the condition of a patient, including ordering tests and interpreting the results;
   
   
2. Discussion with, and providing telephone advice to the patient, patient’s family or patient’s representative(s) even if initiated by the patient, patient’s family or patient’s representative(s); and
   
   
3. Arranging for assessments, procedures or therapy and coordinating community and hospital care including urgent rescue palliative radiation therapy or chemotherapy, blood transfusions, paracentesis/thoracentesis, intravenous therapy, or subcutaneous therapy; 

The new fee includes the Home Care Application and Supervision (K071 and K072) and ongoing telephone management of a patient receiving palliative care at home (G511) fees during the week it is claimed. 

Visit fees, such as K023 Palliative care support, special visit premiums, etc. and any procedures performed are billable in addition and may be claimed for services rendered to patients receiving palliative care in any location including their home, hospital, nursing home, etc.

G512 will be limited to a maximum of one per week per patient and in the event that a patient’s care is transferred from one physician to another, only the physician who rendered the service the majority of the week will be eligible to submit a claim.

In the event of the death of the patient or where care commences on any day of the week, this new fee will be eligible for payment even if the service was not provided for the entire week.

New smoking cessation fees

Two new fees for discussing smoking cessation with a patient who currently smokes will be introduced for the Primary Care Physician most responsible for their patient’s ongoing care to bill.  They are:

1. E079 Initial discussion with patient, to eligible services (add to visit fee) … $15.40; and
   
   
2. K039 Smoking cessation follow-up visit … $33.45

The fee for the initial discussion with the patient is paid in addition to the applicable visit assessment fee, which will be restricted to A001, A003, A004, A005, A006, A007, A008, A903, A905, K005, K007, K013, K017, P003, P004, P005, P008, W001, W002, W003, W004, W008, W010, W102, W104, W107, W109 or W121.   The initial discussion fee is payable only once per patient per 12 month time period.

The follow-up smoking cessation fee is limited to a maximum of two services in the 12 months following the initial discussion with the patient (E079).

Both fees (E079 and K039) require documentation in the patient’s medical record that the smoking cessation discussion has taken place, by either completion of a flow sheet or other documentation consistent with the most current guidelines of the “Clinical Tobacco Intervention” (CTI) program.  A copy of a flow sheet meeting the medical record requirements and guidelines of the CTI program are available at www.oma.org or www.omacti.org.

Medical management of Ectopic Pregnancy

As part of the Appendix K allocation of intra-sectional funding with the Medical Services Payment Committee (MSPC), the Section on Obstetrics and Gynaecology recommended revising the existing medical management codes for early pregnancy and ectopic pregnancy to reflect initial and subsequent visits in appropriate relativity of physician time and effort.  The initial visit A920 Medical management of early pregnancy will be increased to $137.20 and a new fee code for medical management of ectopic pregnancy for the initial visit will be created at a fee of $176.90 (G397 will be deleted).  Follow-up visits for early or ectopic pregnancy will be billed using the current fee code A921, which will be increased to $31.95.

Comprehensive physical medicine and rehabilitation consultation ($197.30)

As part of the Appendix K allocation of intra-sectional funding with the Medical Services Payment Committee (MSPC), the Section on Physical Medicine and Rehabilitation proposed the creation of a new Comprehensive physical medicine and rehabilitation consultation fee. 

As of January 1st, the Section will have a new comprehensive consultation of $197.30.  The new Comprehensive physical medicine and rehabilitation consultation fee requires all the elements of a consultation (A/C/W315) to be fulfilled and has a time requirement of 75 minutes in direct contact with the patient.  Also, the new code will be limited to one claim every 2 years.

New Ophthalmology Assessment Fees

As part of the Appendix K allocation of intra-sectional funding with the Medical Services Payment Committee (MSPC), the Section on Ophthalmology identified specialized practices where patient access to non-surgical ophthalmologic services is becoming difficult. 

Four new codes are to be introduced January 1, 2008:

The Section recommended a distinct fee code for physician services associated with treatment of retinopathy of prematurity (ROP).  This new code would be billed for the initial assessment and all subsequent visits related to ROP for 9 months following birth and/or for any ROP patient with minimum stage 3 long term disease (payable until age 16).

The vision rehabilitation codes would be billed for the treatment of patients with low visual acuity, visual field defect, or significant oculomotor dysfunction. 

The Special ophthalmology assessment code may be claimed a maximum of two times per 12 month period for patients with a psychological problem, developmental delay, learning disability, or significant physical disability which so limits the person’s participation in the assessment that the physician is required to spend a minimum of 20 minutes in direct contact with the patient, family, and/or legal representative.

Please see the new fee code descriptors on pages A54 – A57 of the OHIP Schedule of Benefits for full details on payment requirements.

Revisions to Paediatrics Assessment Fees

As part of the Appendix K allocation of intra-sectional funding with the Medical Services Payment Committee (MSPC), the Section on Paediatrics proposed the creation of a unique code to differentiate their practice activity from that of general practitioners.

As of January 1st, the Section will have a unique basket of codes specific to specialty 26 for their assessments.  The revisions include:

1. A261 Minor assessment descriptor will be revised to Level 1 – Paediatric assessment and be increased to $19.50.
   
   
2. A007 Intermediate Assessment will no longer be listed under Paediatrics.  In its place, a new fee A262 Level 2 – Paediatric assessment will be introduced at a fee of $35.15.
   
   
3. Neurodevelopment consultation (A/C/W667) will be increase to $300, the limit of once every 5 years will be reduce to once every 2 years, and the direct patient time component will be reduced to minimum of 90 minutes from 120 minutes.
   
   
4. E078 chronic disease assessment premium will be applicable to the new A262 code. 

E078 chronic disease assessment premium

Effective January 1, 2008, the list of applicable diagnostic codes will be increased by five to include the following: 

Changes to the payment of operative anaesthesia services

Effective January 1, 2008, time units should be billed for each 15 minutes or part thereof:

Up to and including the first hour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 unit
After the first hour up to and including the first 1.5 hours . . . . . . . . . . . .  2 units
After 1.5 hours  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 units

Time units are calculated on the basis of time spent by the anaesthesiologist and commence when the anaesthesiologist is first in attendance with the patient in the operating room for the purpose of initiating anaesthesia and end when the anaesthesiologist is no longer in attendance (when the patient may safely be placed under customary post-operative supervision). In addition, the basic unit fee will be increased from $12.51 to $13.24.

Surgical assistant base units

Effective January 1, 2008, the minimum basic units provided by surgical assistants for a number of surgical procedures will increase from five to six units and the basic unit fee will be increased from $10.40 to $11.40.