A formal, scheduled session/meeting to discuss/plan medical management of patients with serious and complex pediatric problems. Payable only when coordination of care and two-way collaborative conference with community agency representative and/or health care provider is required e.g.: psychologists, counsellors, long-term care case managers, home care or specialty care nurses, physiotherapists, occupational therapists, social workers, specialists in medicine or psychiatry Ð per _ hour or major portion thereof
Patient must be 18 years of age or younger.
For services related to:
a) psychiatric disorders
b) developmental disorders
c) major chronic disease
d) pre-transplant (concerning donor/recipient assessment)
e) end of lifef) multiple medical handicaps
Maximum of one hour may be claimed per patient per day.
iv) Not to exceed a maximum of four hours per patient per year.
v) The case conference must last at least 15 minutes to submit a claim.
vi) The results of the case conference must be recorded in the patientÕs chart along with the start and end times of the conference, as well as the names and job titles of the other participants at the meeting.
vii) This fee is not payable to physicians who are employed or who are under contract to a facility, agency or program (ie: Ministry of Children and FamiliesÕ FAS, autism and child abuse or neglect assessments, HEAL, health authorities) who otherwise would have attended the conference as a requirement of their employment with the facility, agency or program.
viii) This fee is payable when the care conference occurs in person or by phone
ix) A visit or consult may be payable for the same patient on the same day as a case conference, provided the two items are consecutive, not concurrent, and start and end times are provided for both. A note record must be submitted for consults and patient management conferences occurring on the same day.
x) It may not be claimed unless the pediatrician has a pre-existing relationship with the patient.
xi) Not payable within 3 months of fee item 00511 without a note record explaining the medical necessity.
xii) If multiple patients are discussed, the billings shall be for consecutive, non-overlapping time periods and services are to be claimed under the PHN of each patient for the specific time period.
xiii) Start and end times must be included in time fields.