NEWFOUNDLAND REGULATION 128/97

CNR 1193/96
as amended

1. (1) Section 1.1 of the Preamble to Schedule A of the Medical Care Insurance Physicians and Fees Regulations is amended by deleting the sentence “The remaining portion of Payment Schedule I is represented by the “MCP In-Hospital Diagnostic Schedule.”.

(2) Section 1.3 of the Preamble to Schedule A of the regulations is amended by adding immediately after the word and comma “Procedures,” the words and comma “In-Hospital Diagnostic Procedures,”.

(3) Schedule A of the regulations is amended by adding immediately after the section referring to “Diagnostic and Therapeutic Procedures” the following:

April 1, 1990

IN-HOSPITAL DIAGNOSTIC PROCEDURES

INTRODUCTION

1. In-Hospital Diagnostic Procedures are insured services by MCP and are payable according to the rates outlined in this schedule.

2. Only those providers who are recognized by the Newfoundland Medical Board as specialists in that particular field, e.g. Cardiologists interpreting ECG's, are permitted to bill for these services.

3. The procedures listed in this section are to be billed only when the services are rendered in-hospital. If the same procedures are performed in a non-hospital environment and are insured services by MCP, they must be billed using the fee codes and fees in the Diagnostic and Therapeutic section of the Medical Payment Schedule.

4. Claims must be submitted within 90 days from the date the service is completed. When claims are returned to you for additional information or correction, a further three months is granted for resubmission.

5. Hospital Number - This is a three digit number which identifies the hospital where services are rendered. It must be inserted on the claim form.

56000	Electrocardiogram interpretation........................................................................................	6.84

56010	Stress electrocardiogram (Physician present during testing procedure) Before and after exercise (Master's criteria, Levy Ischemia or Frasher Exercise test) includes complete resting tracing and multiple leads taken immediately and 3 and 6 minutes post exercise...............................................................................	20.70

56020	Maximal stress testing ‑ with treadmill or ergometer and oscilloscopic continuous monitoring, including E.C.G.'s taken during the procedure and resting E.C.G.'s before and after the procedure.................................	41.40

	CONTINUOUS AMBULATORY E.C.G. MONITORING

56050	Interpretation of continuous ambulatory E.C.G. scan....................................................	25.30

56060	Partial review of scan and interpretation..........................................................................	37.40

56070	Complete review of scan.....................................................................................................	63.25
	NOTE: All E.C.G. tracings performed in hospital are to be claimed using this schedule, regardless of where the interpretation is performed.


56500	Schedule A: Complete procedure, e.g. conduction studies on two or more nerves and E.M.G. of multiple muscles; detailed study of neuromuscular transmission...	90.00

56525	Schedule B: Limited procedure, e.g. conduction studies on a single nerve plus limited needle electrode, examination in one area; conduction studies on two nerves without E.M.G..............................................................................................	60.00

56550	Schedule C: Short procedure, e.g. stimulation of a single nerve; repeat E.M.G. of one or two muscles without nerve conduction................................................................	24.15

56575	Single fibre E.M.G...........................................................................................................	70.00
	NOTE: When claiming for the above procedures, consultation or other assessment may not also be claimed unless such assessment is specifically requested by the referring physician or the nature of the illness requires such assessment.

57020	Inserting subtemporal needle electrodes (add).............................................................	13.69

	Polygraphic recording of three parameters in addition to E.E.G. (such as re-spiration, eye movement, E.C.G. muscle movement)
57030	- one item.......................................................................................................................	7.82

57035	‑ two items.....................................................................................................................	15.64

57040	‑ three or more items.....................................................................................................	22.77

	SLEEP APNEA STUDIES

57050	Sleep apnea (overnight study) with continuous monitoring of oxygen saturation and ventilation ‑ to include physician attendance at set up, mon-itoring and interpretation (extra or special visits not chargeable)	114.71

57060	Interpretation of above only.............................................................................................	42.67


57500	Simple average evoked potential studies with one sensory modality of stimulation (interpretation by physician)......................................	20.59

57510	Complex evoked potential studies involving several sensory modalities, multiple threshold determinations of more than four simultaneous channels of recording (partial supervision by physician and interpretation)..........................................................	53.82

57520	Complex evoked potential studies performed completely under the direct supervision of a physician and interpretation.............................	107.93

	OBSTETRICS

57700	*Non‑stress test ‑ interpretation only.........................................................................	6.84
	* If the non‑stress test is done in conjunction with a consultation, the interpretation is considered to be included in the consultation fee.

Code		Fee

58000	Simple spirometry e.g. vital capacity, without permanent record by transducer equipment FVC, FEV, MVV (MBC) etc................................................	1.61
	Standard lung mechanics (with permanent record)
58010	- Vital capacity, FEV, FEV/FVC..............................................................................	4.14

58015	- Repeat of 58010 after bronchodilator.................................................................	1.67

58020	- 58010 plus MMEFR calculation..........................................................................	6.87

58025	- Repeat of 58020 after bronchodilator.................................................................	2.67

58030	- MVV done together with 58010 or 58020...........................................................	.81

	Complex Lung Mechanics
58100	- Functional residual capacity by gas dilution method.......................................	10.67

58110	- Functional residual capacity by body plethysmography................................	10.67

58120	- Airways resistance by plethysmography or estimated using esophageal catheter...............................................................................................................	5.87

58130	Lung Compliance (pressure volume curve of the lung from TLC to FRC)	27.72

58140	Carbon monoxide diffusing capacity by steady state of rest..................................	6.67

58150	Carbon monoxide diffusing capacity by single breath method...............................
10.67Code		Fee

	Pulmonary Function Response to O₂ and CO₂
58160	CO₂ ventilatory response........................................................................................	8.40

58170	O₂ ventilatory response (physician must be present).........................................	12.54

	Exercise Assessment ‑ physician must be in attendance at all times
58180	Exercise diffusing capacity......................................................................................	10.06

58200	Stage I: Graded exercise to maximum tolerance exercise (must include HR, ventilation and E.C.G. at rest and at each workload: E.C.G. monitored at least 5 minutes post exercise).........................................................................	31.85

58210	Same as 58200 plus 58010, 58020 or 58040 before and after exercise................	37.72

58220	Stage II: Repeated steady state graded exercise (must include heart rate, ventilation, VO₂, VCO₂, BP, E.C.G. endtidal and mixed venous CO₂ at rest, 3 levels of exercise and recovery).............................................................................	43.64

58230	Stage III: Same as 58220 plus arterial blood gases, PH and bicarbonate or lactate.........................................................................................................................	65.44

58240	Exercise induced asthma assessment (workload sufficient to achieve a heart rate of 85% of max.; measurement of 58010, 58020 or 58040 before exercise and 5‑10 minutes post exercise)..............................................................................	15.54

	Gas Analysis
58270	Arterial puncture for blood gas analysis..............................................................	6.52

58280	Blood gas analysis: pH, PO₂, PCO₂, bicarbonate and base excess	-

58290	Arterialized venous blood sample collection (e.g. ear lobe)..............................	‑

58300	A‑a oxygen gradient (measurement of RQ by sampling mixed expired gas and using alveolar air equation).............................................................................	16.79

58310	Estimate of venous admixture (Qs/Qt) breathing pure oxygen..........................	10.93

58320	Mixed venous PCO₂ by the rebreathing method.................................................	2.53

58330	O₂ saturation by oximeter (at rest and exercise)...................................................	6.52

58340	Standard O₂ consumption and CO₂ production...................................................	5.52

58350	Histamine or methylcholine threshold test...........................................................	22.54