Diabetes Management by a specialist is a service rendered by a specialist in Endocrinology, Internal Medicine or Paediatrics who is most responsible for providing ongoing management of a diabetic patient. This service includes all services related to the coordination, provision and documentation of ongoing management using a planned care approach consistent with the required elements of the current Canadian Diabetes Association (CDA) Clinical Practice Guidelines. The medical record must document that all of the CDA required elements have been provided for the previous 12 month period and include, at a minimum, the following: a. Lipids, cholesterol, HbA1C, blood pressure, weight and body mass index (BMI), and medication dosage; b. Discussion and offer of preventive measures including vascular protection, influenza and pneumococcal vaccination; c. Health promotion counselling and patient selfmanagement support; d. Albumin to creatinine ratio (ACR); e. Discussion and offer of referral for dilated eye examination; and f. Foot examination and neurologic examination.
1. K045 is limited to a maximum of one service per patient per 12 month period.
2. K045 is only eligible for payment if the physician has rendered a minimum of 4 of any of the following: consultations/assessments, K013, K033, K029, K002, K003 to the same patient in the 12 month period for which K045 is claimed.
3. K045 is only eligible for payment when the physician has greater than 100 patients per year with diabetes.
4. K045 is eligible for payment to a physician from one of the following specialties: Internal Medicine (13), Endocrinology (15) or Paediatrics (26).
K045 is only eligible for payment if the flow sheet and/or a diabetic registry record has been completed for the previous 12 month period including the above listed requirements and is maintained in the patient’s permanent medical record.
Claims for K045 may only be submitted when the required elements of the service have been completed for the previous 12 month period.
A copy of a flow sheet meeting the medical record requirements and CDA Clinical Practice Guidelines may be found at www.oma.org or www.diabetes.ca/forprofessionals/resources/2008cpg
K046 is payable in addition to K045