MEDICAL ASSISTANCE IN DYING

Transcription

1 General Schedule The palliative care counselling tariff code applies to physicians who provide counselling to a patient with a terminal disease such as cancer, AIDS or advanced neurological disease and/or counselling to that patient s family. The goal of palliative care is achievement of the best possible quality of life for people for whom cure is no longer possible. Specifically, A patient or family member may request a counselling session with the physician because of specialized management of a patient with terminal illness. Counselling session may be with the patient, with the patient and the family, or with the family without the patient present. Palliative care counselling generally is provided during a period not greater than three (3) months prior to death. Where circumstances require a longer duration of palliative care, this may be claimed By Report. Tariff rate is payable for the first full fifteen (15) minute period and for each additional fifteen (15) minute period or major portion thereof. Counselling beyond one (1) hour must be submitted By Report. MEDICAL ASSISTANCE IN DYING ~8635 Administering Physician Medical assistance in dying, assessment, counselling, examination and administration, per fifteen (15) minutes or major portion thereof ~8636 Independent Asssessing Physician or Provincial MAID Clinical Services Team Physician Medical assistance in dying, assessment, counselling, examination and administrative tasks, per fifteen (15) minutes or major portion thereof ) Tariffs ~8635 and ~8636 are for all services directly related to medical assistance in dying in accordance with any College of Physicians and Surgeons of Manitoba Standard of Practice related to medical assistance in dying services including but are not limited to: i) History taking; ii) iii) iv) Assessment including examination and/or review of relevant medical history; Conferences with the patient, family members, the Administering Practitioner, the Independent Assessing Practitioner members of the Provincial MAID Clinical Services Team or other health care professionals; Reviewing and writing medical reports or other correspondence. Telephone calls; v) Counselling of patient and/or family; vi) vii) viii) Assessment of decision making capacity and consent; Arranging referrals/consultations to physicians and other health care professionals; Administrative tasks including completing forms and reports including documentation in the patient s medical record; 2) The start and end time for providing the services shall be documented on the claim. B-14 April 1, 2016

2 General Schedule 3) Services unrelated to medical assistance in dying provided by the Administering Physician, the Independent Assessor or any other physician including visits or examinations related to the ongoing treatment or care of the patient may be claimed in addition to ~8635 and ~ ) All claims shall include one of the following remarks indicating the nature of the service provided: i) clinical services or assessment (to indicate clinical services, medical assessment, assessments of decision making capacity and consent, etc.); ii) counselling (may include person and/or family); iii) administrative (may include arranging referrals, consultations, review of documentation, completion of forms and reports, conferences etc.). Where remarks are provided descriptive reports are not required. 5) ~8635 may only be claimed only by the Administering Physician who is providing services in accordance with any CPSM Standard of Practice. 6) ~8636 may be claimed only by the physician who is providing an independent assessment in accordance with the CPSM Standard of Practice or by a member of the Provincial MAID Clinical Services Team as determined by the CMO of the WRHA. CHRONIC CARE 8511 Chronic Care, per visit See Rule 18 ALLEGED SEXUAL ASSAULT 8578 Female Male This is an all-inclusive fee except that a special call, if appropriate, will be paid. A portion of each benefit is for the collection of evidence and will be recovered by the Minister from the Department of the Attorney-General. To be eligible for the above benefits, the evidence must be collected and the documentation submitted to the appropriate law enforcement agency. If evidence is not collected and submitted, the physician may claim the appropriate visit fee and a special call if appropriate, or detention time Tariff 8574 when appropriate and should not claim tariffs 8578 or BLOOD ALCOHOL SAMPLING 8577 Blood alcohol sampling This benefit covers the following: 1) a) Assessment to determine that obtaining a sample is safe. b) Assessment of the patient s ability to consent to the procedure. c) Completing the police form. April 1, 2016 B-15

3 Anesthesia TARIFF PROCEDURE UNITS 2107 Epiaortic/Epicardiac Ultrasound Study and on-heart monitoring...30 This tariff may not be claimed in addition to Tariff Fast Track Recovery Intensive Care Cardiac Science Unit a) The unit value of the Fast Track Recovery Intensive Care Cardiac Sciences service is units per fifteen (15) minute period or portion thereof, and claimed under tariff b) Out-of-hours premiums may not be claimed in addition to c) Other services rendered concurrently cannot be claimed in addition to d) The total amount of fifteen (15) minute time periods claimed for 8277, as a total across all physicians, may not exceed forty (40) time periods (i.e. ten (10) hours) per day. e) 8277 may only be claimed by Attending Fast Track Cardiac Anesthesiologists who provide in-hospital coverage of the Intensive Care Cardiac Science Unit at St. Boniface General Hospital. f) The start and stop times for providing the services, shall be submitted on the claim. Anesthesia Miscellaneous Local Anesthesia Local injections to anesthetize an area through absorption by area nerves This includes anesthetic injected directly into desired area or injected proximally for absorption into nerves supplying the area, (e.g. ring anesthesia in a finger proximal to the area; but does not include specific nerve blocks.) This excludes topical anesthesia. [per fifteen (15) minute period or portion thereof] 6999 Dental Anesthesia Multi-organ donor April 1, 2016 C-39

4 Musculoskeletal System 0580 Radical resection of bone for tumor with bone grafting, if required, maxilla, femur, humerus, pelvis, scapula and tibia other bones Unlisted or Unusually Complicated... By Report CRANIOFACIAL SURGERY 1) When the surgical assistant is a specialist (e.g. neurosurgeon or plastic surgeon), assistant s benefits will be 30% of the surgical fee; otherwise 25% applies. 2) Those benefits denoted by + include harvesting of bone and cartilage grafts Lefort II maxillary osteotomy and advancement... 1, Onlay bone grafts to face when not part of standard osteotomy for reconstruction, maxilla unilateral bilateral zygoma unilateral bilateral frontal unilateral bilateral Forward bilateral osteotomy of the zygoma including bone graft Bilateral periorbital correction, Treacher-Collins Syndrome with or without bone grafts (extracranial)... 1, Bilateral periorbital correction, Treacher-Collins Syndrome with skull and muscle transpositions (includes skull reconstruction intracranial)... 1, Lefort III total maxillary advancement... 2, Lefort III and subcranial hypertelorism and correction... 2, Lefort III and Lefort I maxillary advancement... 2, Lefort II, subcranial hypertelorism correction, Lefort I maxillary advancement... 2, Upper Lefort III advancement without occlusal change, unilateral Forehead advancement (bone grafts not included), unilateral... 1, bilateral... 1, Mandibular osteoplasty for prognathism or micrognathism, one (1) or two (2) stages Intra-operative monitoring of cranial/facial nerves remote from the skull base, add may only be claimed in addition to the following tariffs, 0616, 2666, 2927, 2934, 4972, 5957, 5971, 5973, 5974, 5976, 5977, 5992, and Cranial vault reshaping anterior or posterior half... 1, Total cranial vault reshaping... 1, F-4 April 1, 2016

5 Musculoskeletal System SPINE ANTERIOR AND POSTERIOR PROCEDURES When anterior and posterior spinal procedures are performed on the same day, same anesthetic, the higher fee is payable at 100% and the lesser fee is payable at 85%. Notwithstanding that the lesser fee is payable at 85%, all procedures that include the word add are to be paid at 100%. SPINE APPROACH 1230 Trans abdominal or retroperitoneal approach to spine Benefit payable when spinal surgical service(s) is performed by a different surgeon. ANTERIOR INSTRUMENTATION Cervical C2-C two (2) vertebrae... 1, add on per additional vertebra Cervico-Thoracic C7-T two (2) vertebrae... 1, add on per additional vertebra Dorsal 0645 Anterior Instrumentation of Spine and/or Osteotomy, via chest via abdomen... 1, via chest and abdomen... 1, DECOMPRESSION Cervical-Thoracic-Lumbar 5203 Intervertebral discs, excision anterior approach, cervical... 1, Laminectomy laminae only for decompression of the spinal cord and nerve roots unilateral first level bilateral, first level Laminectomy for lesion, laminae only for decompression of spinal cord or meninges unilateral first level... 1, bilateral, first level... 1, each additional vertebral level (unilateral or bilateral) add to 5205, 5200, 5207 or Laminotomy, cervical... 1, F-6 April 1, 2016

6 Musculoskeletal System 1074 Excision of lumbar intervertebral disc, one (1), all methods, any approach e.g. minimally invasive, includes all associated bone and soft tissue procedures e.g. laminotomy, foraminotomy, laminectomy, facetectomy, fat graft, microscope, fluoroscopy... 1, more than one (1)... 1, Vertebrectomy including disc and adjacent end plates, add... 1, per additional vertebra, add Total disc excision with end plates for fusion or disc replacement, add per additional vertebra, add Partial vertebrectomy, add Posteriolateral decompressions of the vertebral body must include lamina, and complete laminectomy and a portion of facets, pedicles, unilateral first level, add... 1, bilateral, first level, add... 1, each additional vertebral level (unilateral or bilateral), add to 1114 or FUSION-CERVICAL POSTERIOR FUSION 1116 Occipito-cervical fusion (includes wires, screws and graft when necessary)... 2, add on per vertebra below C C1-C2 fusion wires and graft C1-C2 fusion including transarticular screws and wires... 1, add on flat bone graft CERVICO-THORACIC-LUMBAR 0636 Spine, two (2) vertebrae, (e.g. lumbo-sacral) three (3) to five (5) vertebrae... 1, More than five (5) vertebrae... 1, Posterior or Posteriolateral fusion with instrumentation including pedicle screws, two (2) vertebrae... 1, add on per additional vertebra add on per Sacral vertebra (maximum per patient $3,000.00) ALIF OR PLIF Alif-(anteriorlumbar interbody fusion) Plif-(posteriorlumbar interbody fusion) 1124 Vertebra Replacement with autogenous or allograft bone, cement, tri-cortical bone and/or cage per vertebra, add Partial vertebral replacement with autogenous or allograft bone, cement, tricortical bone and/or cage per vertebra, add April 1, 2016 F-7

7 Musculoskeletal System 1126 Intervertebral disc replacement any type for radical disc excision tricortical strut graft, autograft, allograft, bone cement prosthetic with or without cage, per vertebra, add Artificial disc insertion... 1, each additional level replaced, add Anterior Release includes discectomy and section of longitudinal ligament including open or thoroscopic approach, through posterior or posteriolateral approach 1128 one (1) intervertebral disc space two (2) three (3) intervertebral disc spaces... 1, four (4) six (6) intervertebral disc spaces... 3, Greater than six (6) intervertebral disc spaces (per disc space) (maximum per patient including fusion $3,000.00), add Fusion with anterior release with morsellized non-structural bone graft per intervertebral disc space, add BONE GRAFT Procurement and application of graft from remote site 1100 Morsellized bone graft (allograft, not synthetic bone graft), to one or more sites, add Onlay graft for posterior lateral fusion, add MISCELLANEOUS 1134 Laminoplasty add on per additional vertebra Odontoidectomy, transoral with microscope... 1, Open Vertebroplasty, posterior approach with augmentation of bone with autograft, bone cement or bone substitute... 1, Odontoid fracture open reduction and interior fixation with screw... 1, Multi vertebral level saucerization of spinal wound with re-opening of the initial incision down to the spine for major infection, drainage of hematoma, including debridement, add ) Where required, re-instrumentation may be claimed in addition to Tariff ) Payable in the post operative period Intra-operative ultrasound, add MEP/SSEP electro-physiological monitoring, primary spine surgeon, add MEP/SSEP electro-physiological monitoring, non-operating physician per hour or major portion F-8 April 1, 2016

8 Musculoskeletal System 1209 Removal of hardware (plates, pins, wires, screws, etc.) from the spine, add ) Not payable for scar excision or exploration of the fusion mass. 2) Where required, re-instrumentation may be claimed in addition to Complete Spinal Duraplasty requiring application of a graft for degenerative or traumatic tears (autologous, allogenic, synthetic), add FRACTURES These benefits cannot be correctly interpreted without reference to Rules of Application 34 to 42. In compound fractures requiring closed reduction $47.00 may be added to the fee for closed reduction. HEAD Skull, non operative depressed with operation See Nervous System FACIAL BONES 0686 Nasal, simple, closed reduction with or without nasal packing or splinting compound, closed reduction simple or compound, open reduction Malar, simple, closed reduction simple or compound, depressed, open reduction multiple surgical procedures Maxilla, simple, closed reduction simple or compound, closed reduction with wiring of teeth simple or compound, open reduction with wiring of teeth or local fixation Mandible, simple, closed reduction simple or compound, closed reduction and wiring of teeth simple or compound, open reduction skeletal pinning with external fixation SPINE AND TRUNK 0739 Clavicle, closed reduction child adult open reduction Sacrum, reduction, closed or open... By Report Ribs, where operative procedure necessary... By Report Scapula, open reduction Sternum, reduction, closed or open... By Report April 1, 2016 F-9

9 Hemic and Lymphatic Systems INCISION 2631* Abscess of lymph node, simple drainage REVISION AND REPAIR 2696 Thoracic duct repair RESECTION 2665 Lymphadenectomy, cervical, radical, unilateral suprahyoid, unilateral bilateral axilla, radical inguinal, superficial iliac, deep retroperitoneal, including pelvic, aortic and renal dissection... 1, staging pelvic lymphadenectomy for prostate cancer Primary retroperitoneal lymphadenectomy, thoracoabdominal or transperitoneal, for testis cancer... 1, for post chemotherapy patients, add Modifed Radical Neck Dissection including removal of all cervical lymph nodes (level 1-5 inclusive) with preservation of any or all of the sternocleidomastoid muscle, the internal jugular vein and the accessory nerve... 1, Intra-operative monitoring of cranial/facial nerves remote from the skull base, add may only be claimed in addition to the following tariffs, 0616, 2666, 2927, 2934, 4972, 5957, 5971, 5973, 5974, 5975, 5976, 5977, 5992 and Unlisted or Unusually Complicated... By Report SPLEEN INVESTIGATION 2602* Needle biopsy Biopsy of spleen when exposed at other operations REPAIR 2604 Suture repair or partial splenectomy (excluding intraoperative trauma)... By Report RESECTION 2601 Splenectomy Unlisted or Unusually Complicated... By Report I-2 April 1, 2016

10 Digestive System RESECTION 2975 Nasopharyngeal fibroma... By Report Branchial cleft cyst or sinus, subcutaneous deep Pharyngeal diverticulum resection and/or crico-pharyngeal myotomy Adenoidectomy alone Tonsillectomy with or without adenoidectomy or uvulectomy, child under thirteen (13) years adult * Tonsil tag, local anesthesia * general anesthesia Unlisted or Unusually Complicated... By Report SALIVARY GLAND AND DUCTS 5996 Intra-operative monitoring of cranial/facial nerves remote from the skull base, add may only be claimed in addition to the following tariffs, 0616, 2666, 2927, 2934, 4972, 5957, 5971, 5973, 5974, 5975, 5976, 5977, 5992 and INVESTIGATION 2921* Biopsy salivary gland INCISION 2915* Submaxillary or parotid duct calculus, uncomplicated, intraoral removal, office procedure difficult, intraoral removal in hospital Parotid calculus, extra-oral removal * Submaxillary or parotid abscess drainage REVISION AND REPAIR 2961* Salivary duct dilation plastic repair Salivary fistula closure Rerouting of submandibular ducts RESECTION 2930 Submaxillary tumor and/or submandibular gland excision and/or sublingual gland excision Superficial parotid tumor, excision without nerve dissection J-4 April 1, 2016

11 Endocrine System O ENDOCRINE SYSTEM These benefits cannot be correctly interpreted without reference to the Rules of Application. THYROID INVESTIGATION 4910* Needle aspiration biopsy (cytology) * Needle core biopsy (histology) * Needle biopsy of Neck Masses Open biopsy INCISION 4940* Aspiration of thyroid cyst * Thyroglossal duct cyst incision and drainage RESECTION 4911 Thyroidectomy, adenoma or cyst excision Lobectomy, unilateral or subtotal thyroidectomy total thyroidectomy... 1, Thyroglossal duct cyst or sinus excision Unlisted or Unusually Complicated... By Report PARATHYROID RESECTION 4971 Exploration of the neck and/or removal of parathyroids or parathyroid tumor... 1, Mediastinal exploration by splitting of the sternum Intra-operative monitoring of cranial/facial nerves remote from the skull base, add may only be claimed in addition to the following tariffs, 0616, 2666, 2927, 2934, 4972, 5957, 5971, 5973, 5974, 5975, 5976, 5977, 5992 and Unlisted or Unusually Complicated... By Report April 1, 2016 O-1

12 Nervous System STEREOTACTIC SURGERY FOR INTRACRANIAL LESIONS, CYSTS OR ABSCESSES 5107 Computed tomography guided stereotactic surgery for needle biopsy of intracranial lesions, and for drainage of intracranial cysts or abscesses, to include ventriculography with implantation and removal of radioactive sources in the brain, add Gamma Knife Radiosurgery Neurosurgery component ) Includes the review of submitted data, application of the stereotactic frame to the patient s head and revision and review of obtained images (either CT and/or MRI), the outline of the treatment plan and attendance with the patient for the duration of the radiosurgery. 2) This surgery should be done in conjunction with the radiation oncologist Gamma Knife Radiosurgery Radiation Oncology Component ) Includes entering data from CT scan into the treatment planning computer, determining the treatment plan and prescription with the radiotherapy physicist, responsibility for the administration of the single fraction radiosurgery and presence throughout the entire procedure. 2) This procedure is done in conjunction with the neurosurgeon. SPINE AND SPINAL CORD Laminotomy Lumbar See Arthrectomy 5201 Cordotomy, cervico-dorsal Percutaneous cordotomy (thermocoagulation technique), unilateral Intervertebral discs, excision anterior approach, cervical... 1, Laminectomy laminae only for decompression of the spinal cord and nerve roots unilateral first level bilateral, first level Laminectomy for lesion, laminae only for decompression of spinal cord or meninges unilateral first level... 1, bilateral, first level... 1, each additional vertebral level (unilateral or bilateral) add to 5205, 5200, 5207 or Laminotomy, cervical... 1, Lumbar subarachnoid-peritoneal-ureteral shunt Meningocele, repair Meningomyelocele Rhizotomy Percutaneous implantation of neurostimulator electrodes, epidural or intradural Laminectomy for implantation of neurostimulator, epidural electrodes Q-10 April 1, 2016

13 Ocular System R OCULAR SYSTEM These benefits cannot be correctly interpreted without reference to the Rules of Application. SPECIAL DIAGNOSTIC OCULAR TESTS 9855* Contact lens fitting, supervision for six (6) months, including three (3) visits Initial fitting of contact lens following congenital cataract surgery [fee includes cost of lenses and services for six (6) months]... By Report 9815* Diurnal tension curve bilateral * Electroretinography ~9655 Mutifocal Electroretinogram, bilateral ~9656 Dark Adaptation Curve, bilateral Tariffs ~9655 and ~9656 are payable only when provided at Misericordia Health Centre or Children s Hospital. 5635* Examination under general anesthesia The above cannot be claimed together with a non-asterisked procedure at the same sitting. 9856* Fluorescein fundus angiography, total * professional * Fluorescein fundus angioscopy * Fundus photography (mm or Polaroid), unilateral or bilateral * Glaucoma, provocative test * Gonioscopy or three mirror examination, bilateral * Indirect ophthalmoscopy with scleral depressions for complete examination of the fundus and periphery with detailed drawing in patients with retinal pathology or suspected retinal pathology An indirect ophthalmoscopy examination without a detailed drawing of pathology is often part of a routine eye examination. Tariff 9858 is not to be claimed in such circumstances. 9854* Low vision aid assessment * Special muscle studies * Subconjunctival injection (independent procedure) * Tonography The above is done by a machine which makes a graph. Tonometry the measurement only, is part of refractions and when done separately is included in the office visit. 9853* Visual fields, perimetry or tangent screen * perimetry and tangent screen April 1, 2016 R-1

14 Audio-Vestibular System MIDDLE EAR 5996 Intra-operative monitoring of cranial/facial nerves remote from the skull base, add may only be claimed in addition to the following tariffs, 0616, 2666, 2927, 2934, 4972, 5957, 5971, 5973, 5974, 5975, 5976, 5977, 5992 and Labyrinthotomy or labyrinthectomy Mastoid obliteration * Cautery and patching of ear drum Mastoidectomy, cortical radical or modified radical Temporal Bone Resection for neoplasm, subtotal and lateral, to include mastoidectomy and excision of external auditory canal but not including muscle flap reconstruction.... 2, Muscle flap reconstruction is payable in addition under Tariff Implantation of electromagnetic bone conductor hearing device Myringoplasty Polyp, middle ear, removal in hospital Post-aural fistula, closure Stapedectomy with prosthesis, fenestration of oval window Stapes mobilization Tympanoplasty with mastoidectomy... 1, without mastoidectomy Myringotomy, with insertion of tubes, unilateral or bilateral removal of tubes under general anesthetic Tympanotomy, exploratory for deafness or other reason Cochlear implant insertion, unilateral, with or without mastoidectomy, posterior tympanotomy, includes free tissue harvest for cochleostomy obliteration and musculoperiosteal temporalis muscle rotation flap... 1, Revision cochlear implant, for removal of old implant and insertion of new implant with or without mastoidectomy, posterior tympanotomy, includes free tissue harvest for chochleostomy obliteration and musculoperiosteal temporalis muscle rotation flap... 1, Major congenital ear anomalies operations unilateral (up to a maximum of $667.00)... By Report less than major procedures, unilateral... By Report Endolymphatic shunt, unilateral Posterior tympanotomy with full ear reconstruction, unilateral Closure of perilymph fistula Iontophoresis of middle ear, per treatment April 1, 2016 S-3