CONCOMITANT CARE CHRONIC CARE SEE GENERAL SCHEDULE

Transcription

1 Gastroenterology (01-5) 8664 Extended Consultation Unassigned Patient Child minimum of forty-five (45) minutes of patient/physician contact time ) Patient must be under eighteen (18) years of age. 2) Patient/physician contact time must be documented with start and stop times on the patient s record. Patient/physician contact time is defined as time the physician spends directly in the presence of the patient for the purposes of examination, discussion and/or explanation. It does not include time spent reviewing records or tests, or arranging for further services or communication with others, either in writing or by telephone. Time spent performing procedures for which another tariff is claimable may not be counted towards contact time for the purposes of an extended visit Consultation Unassigned Patient Unassigned Patient means a patient who requires assessment by a Gastroenterologist, who has not rendered a Complete History and Physical Examination (tariff 8540) or Consultation service (tariff 8550 or tariff 8595) to that patient within the last twelve (12) consecutive months. Rules of Application 7 to 10 inclusive apply Regional History and Examination Hospital Care per day Clinical Teaching Unit (CTU) patient care supplement per day ) May be claimed by the CTU attending physician for each patient admitted to a CTU designated by Manitoba Health. 2) Tariff 8520 and/or other applicable visit/examination services are payable in addition. CONCOMITANT CARE 8524 Concomitant Care per day CHRONIC CARE SEE GENERAL SCHEDULE April 1, 2017 A-13

2 General Practice (11) Comprehensive Care 5) The services in Note 3) must be documented and provided to Manitoba Health either a) by an electronic medical record compatible with Manitoba Health s information system or b) by completing Manitoba Health s patient care treatment form which shall be forwarded to Manitoba Health either electronically or by fax. 6) Claims for additional services rendered to a patient (e.g., visits) may be made in addition to this tariff Annual management of primary care for a patient between years of age without a chronic disease Annual management of primary care for a patient 75 years of age and over without a chronic disease Annual management of primary care for a patient diagnosed with one chronic disease Annual management of primary care for a patient diagnosed with two chronic diseases Annual management of primary care for a patient diagnosed with three or more chronic diseases ) Tariffs may only be claimed for enrolled patients. Enrolled patient means a patient with whom a physician, or his/her team, has reached an agreement to be the patient s most responsible primary care provider. Enrollment must be denoted in the EMR and communicated to Manitoba Health in a format compatible with Manitoba Health s information system and delivered securely through (a) one of the mechanisms referenced in Note 8, or (b) a web based enrollment portal. 2) Tariffs may only be claimed by physicians who provide comprehensive care to enrolled patients and have provided Manitoba Health, Primary Care Branch the location of the clinic (address and contact information), and number and type of practitioners providing services at that location. 3) Tariffs are payable only to the physician who has provided the patient ongoing comprehensive primary care during the preceding twelve (12) months. 4) Physician or member of his/her team must provide: i) Medical services consistent with the applicable indicators in the Manitoba Primary Care Quality Indicators Guide (version 2.0 or such other version(s) as agreed to by the parties). Services shall be documented in the EMR. ii) Ongoing coordination with other health care providers respecting management of patient condition(s) and patient care plan; and iii) Ongoing communication with patient, monitoring of patient condition(s) and patient care plan. A-70 April 1, 2017

3 General Practice (11) 5) Tariffs 8454, 8455, 8456, 8457 and 8458 may only be claimed once per patient during any twelve (12) month period and cannot be claimed in combination with any other Comprehensive Care Tariff or Chronic Disease Management Tariff. 6) Claims for additional services rendered to an enrolled patient (e.g., visits) may be made in addition. 7) Physicians must use an EMR and services must be documented in such EMR. 8) The services in Note 4(i) must be documented in the EMR and communicated to Manitoba Health via data extracts compatible with Manitoba Health s information system and delivered securely, either (a) through a secure electronic interface (EMR extract) on a monthly basis, or (b) on an encrypted electronic device (e.g. CD or flash drive), on a quarterly basis (commencing on April 1 of each year), within 15 calendar days of the end of each quarter. 9) For the purpose of 8454, 8455, 8456, 8457 and 8458 a chronic disease shall be Diabetes, Asthma, Congestive Heart Failure, Hypertension, Coronary Artery Disease. April 1, 2017 A-71

4 Therapeutic Injections and Immunizations Immunizations Immunizations are an excluded service for purposes of travel, employment and emigration, and may only be claimed if the injection is for a publicly funded vaccine administered in accordance with the eligibility criteria as is determined from time to time by the Communicable Disease Control Branch of Manitoba Health. The eligibility criteria for most publicly funded vaccines can be found on Manitoba Health s website at ACTIVE IMMUNIZING AGENTS BCG Bacillus Calmette Guérin 8731 single dose DTaP IPV Diphtheria, Tetanus, acellular Pertussis, Inactivated Polio Virus paediatric 8924 single dose DTaP IPV Hib Diphtheria, Tetanus, acellular Pertussis, Inactivated Polio Virus, Haemophilus influenza type b paediatric 8802 single dose HA Hepatitis A 8904 single dose HAHB Hepatitis A and B 8899 single dose HB Hepatitis B 8913 single dose Hib Haemophilus influenzae type b 8901 single dose HPV Human Papillomavirus type 6, 11, 16, single dose Inf(s) Influenza seasonal 8791 single dose Inf ITN Influenza Intranasal 8969 single dose Inf ph1n1(adj) Influenza pandemic H1N1 adjuvanted Inf ph1n1 (unadj) Influenza pandemic H1N1 unadjuvanted IPV Inactivated Polio Virus 8931 single dose Men B Multicomponent Meningococcal B 8970 single dose B-30 April 1, 2017

5 Therapeutic Injections and Immunizations Men C C Meningococcal C Conjugate 8685 single dose Men P ACWY Meningococcal Polysaccharide ACWY 8981 single dose Men C ACWY 135 Meningococcal Conjugate ACWY 8990 single dose MMR Measles, Mumps, Rubella 8670 single dose MMRV Measles Mumps Rubella Varicella 8671 single dose Pneu C 13 Pneumococcal Conjugate 13 valent 8896 single dose Pneu P 23 Pneumococcal Polysaccharide 23-valent 8961 single dose Rab Rabies post exposure 8751 single dose Rab Rabies Vaccine pre exposure 8761 single dose Rot Rotavirus 8897 single dose Td Tetanus, Diphtheria adult 8651 single dose TdaP Tetanus, Diphtheria, accellular Pertussis adult 8907 single dose Tdap IPV Tet dipth Apertussis Ipolio 8964 single dose Td IPV Tetanus, Diphtheria, Inactivated Polio Virus adult 8805 single dose Var Varicella 8674 single dose PASSIVE IMMUNIZING AGENTS BAtx Botulism Antitoxin 8910 single dose DAtx Diphtheria Antitoxin 8928 single dose April 1, 2017 B-31

6 Respiratory System UNIT VALUE 2024 bilateral and polypectomy and ethmoidectomy, unilateral bilateral and polypectomy and ethmoidectomy and antrostomy, unilateral bilateral... 1, and ethmoidectomy and antrostomy, unilateral and ethmoidectomy and antrostomy, bilateral Unlisted or Unusually Complicated... By Report LARYNX Cervical lymph node dissection See Lymph Nodes 2071* Laryngoscopy, direct, diagnostic * direct, with biopsy * direct for foreign body removal (in office) * Fiberoptic nasendoscopy nasopharyngoscopy flexible * Fiberoptic nasopharyngolaryngoscopy flexible These items may be claimed by appropriately trained specialists only where visualization of the larynx or nasopharynx has failed with the laryngeal mirror Suspension micro-laryngoscopy without CO² laser Suspension laryngoscopy with removal of complicated lesion from larynx or trachea by CO² laser Laryngogram (procedural portion of Radiology) Arytenoidectomy, external approach Laryngectomy, partial, with preservation of voice total... 1, ~2050 Vocal cord injection * (Fiberoptic nasopharyngolaryngoscopy flexible) may not be claimed in addition Thyroplasty with Silastic Implant Laryngo-fissure with removal of tumor or laryngocele Laryngoscopy, direct with complete removal of cord lesion with foreign body removal G-4 April 1, 2017

7 Urinary System UNIT VALUE 3965 Fistula, closure, vesicorectal vesicouterine vesicovaginal when a colostomy is part of the above, add Perivesical or prevesical space abscess drainage * Manual clot evacuation from bladder Tumor bladder, excision Cystostomy, closure (independent procedure) Diversion, urinary, to isolated intestine where bladder is mobilized and anastomosed to intestinal segment... 1, Bladder augmentation with intestine or stomach... 1, * Chemotherapeutic instillations in bladder, per instillation, to include necessary catheterization (professional fee only) Intravesicle Botulinum Toxin Injection Includes cystoscopy. CYSTOSCOPY THERAPEUTIC 3940* With fulguration or treatment of minor (less than 0.5 cm.) lesion, with or without biopsy Bladder tumors, small (0.5 cm. to 2.0 cm.) fulguration, initial subsequent, (i.e. during same hospital admission) large, transurethral resection Radioactive substance, insertion, with or without biopsy or fulguration Interstitial cystitis, dilatation, electro- and/or chemo-fulguration, under general anesthetic Collagen injection periurethral/ureteral under cystoscopy control Foreign body, including calculus, removal from bladder or urethra Calculus in bladder, litholapaxy Ileal loop creation, and transplanting ureters to it (without cystectomy)... 1, CYSTECTOMY 3911 partial, without ureter transplants with one or both ureter transplants to bladder ~3995 Radical cystectomy (includes resection of seminal vesicles, or uterus and ovaries)... 1, ~3996 creation of ileal conduit and transplantation of ureters to ileal conduit, add ~3997 creation of continent urinary diversion (catheterizable pouch or neobladder) and transplantation of ureters to urinary diversion, add Only one of Tariffs ~3996 or ~3997 may be claimed with ~3995. K-6 April 1, 2017

8 Urinary System ~3998 extended lymphadenectomy for bladder cancer (to the level of the bifurcation of the great vessels), add Tariff ~3998 may only be claimed with ~3995. UNIT VALUE 3919 Unlisted or Unusually Complicated... By Report URETHRA 3978 Abscess, periurethral, drainage Caruncle, urethral, excision or fulguration * Urethral stricture, dilatation, male, initial * subsequent * under general anesthesia * female, local for general anesthesia see Rule of Application * Meatotomy, male (independent procedure) * female, including meatoplasty * Urethroscopy, diagnostic, initial or subsequent Wounds, urethral: urethrorrhaphy... By Report Urethroplasty, plastic operation on urethra... By Report URETHROSCOPY THERAPEUTIC 4006 With fulguration of posterior urethra With internal urethrotomy, blind With visual internal urethrotomy using cold knife urethrotome With removal of calculus or foreign body * Urethrotomy, external, anterior * perineal Polyps, urethral, excision or fulguration with or without urethroscopy Diverticulum of urethra, excision (independent procedure) Urinary, extravasation, simple perineal drainage (independent procedure) complicated Extravasation, perineal urinary, drainage with diversion of urinary stream Fistula, urethral, closure (independent procedure)... By Report urethrovaginal closure Urethrectomy, perineal approach Unlisted or Unusually Complicated... By Report April 1, 2017 K-7