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Newfoundland Regulation 1998


NEWFOUNDLAND REGULATION 26/98

NEWFOUNDLAND REGULATION 26/98

Medical Care Insurance Physicians and
Fees Regulations (Amendment)

under the
Medical Care Insurance Act

(Filed February 6, 1998)

Under the authority of section 48 of the Medical Care Insurance Act, the Newfoundland Medical Care Commission with the approval of the Minister of Health makes the following regulations.

Dated at St. John s, February 6, 1998.

R.O. Peddigrew
for the Chairman,
Newfoundland Medical Care Commission

REGULATION

Analysis


        1.   Sch A Amdt.
Complex Assessment
Visit Codes Added


CNR 1193/96
as amended

        1. (1) Section 2.5.1 of the Preamble to Schedule A of the Medical Care Insurance Physicians and Fees Regulations is amended by adding immediately after the third sentence the following:

A General Assessment cannot be claimed by physicians when they are providing dedicated on-site Emergency Department coverage at designated hospital facilities which are listed in Appendix A to this Preamble.

             (2)  Section 2.5 of the Preamble to Schedule A of the regulations is amended by adding immediately after Section 2.5.3 the following:

  2.5.4 Complex Assessment

A Complex Assessment is payable to physicians when they are providing dedicated on-site Emergency Department Coverage at designated hospital facilities listed in Appendix A to this Preamble. The following services qualify for claiming a Complex Assessment:

             (a)  Evaluation of a new or existing medical condition that necessitates a detailed medical history, review of previous medical records and necessary physical examination of three or more organ systems. It may include a review of diagnostic tests and the initiation of appropriate therapy/treatment. For the purposes of claiming this code the organ systems are defined as: cardiovascular, respiratory, digestive, genitourinary, musculoskeletal, hemolymphatic, nervous, integumentary, nervous, ears-nose-throat, ophthalmic and mental.

OR

             (b)  Prolonged observation and/or continuous therapy and multiple reassessments (not including the discharge assessment) of patients whose illness requires it.

OR

             (c)  Management of patients presenting with life or limb threatening illness or injury that requires immediate evaluation and/or intervention and/or emergent treatment by the physician.”.

             (3)  Section 2.6 of the Preamble to Schedule A of the regulations is amended by adding immediately after the second sentence the following:

A General Reassessment cannot be claimed by physicians when they are providing dedicated on-site Emergency Department coverage at designated hospital facilities listed in Appendix A to this Preamble.

             (4)  The Consultations and Visits - General Practice section of Schedule A is amended by adding immediately after fee code “481 Detention (see definition in Preamble) per 1/4 hour                   .... 16.35” the following:

Physician on Duty at Designated 24 hour on-Site
Emergency Department (Appendix A)

401

Consultation

34.50

411

Pre-dental assessment

33.50

416

Complex assessment (Monday to Friday)

26.55

417

Complex assessment (Saturday, Sunday and Statutory Holidays)

29.21

421

Partial assessment

12.00

 

Psychotherapy

 

431

    Individual, per ½ hour or major part thereof

20.50

432

    Group (4 to 8 people) per member, per hour or
        major part thereof

6.54

436

    Family therapy (2 or more family members) per
        ½ hr., per family

15.26

481

Detention per 1/4 hr

16.35