This is an annual fee payable to a specialist in internal medicine or endocrinology for the comprehensive teambased care of a patient with diabetes. The diabetes management team must include the specialist most responsible for the diabetes management of the patient and at least one or more Certified Diabetes Educators (CDE). DTM includes all services related to the coordination, provision and documentation of all required elements of ongoing care, as necessary, by the physician and/or the CDE.
1. A maximum of one K046 is eligible for payment per patient per 12 month period.
2. K046 is only eligible for payment if all of the following requirements are fulfilled:
a. the physician has rendered a minimum of 4 of any combination of consultations/assessments or K013, K033, K029, K002, K003 to the same patient in the 12 month period for which K046 is claimed;
b. the CDE is an employee of the physician;
c. when the physician has treated more than 100 patients with diabetes during the period for which K046 is claimed; and
d. the physician is from one of the following specialities: Internal Medicine (13) or Endocrinology (15).
3. K046 is not eligible for payment unless the physician documents the services rendered by the CDE. The physician must provide such documentation to the ministry, if requested.
4. The CDE must have current certification by the Canadian Diabetes Educator Certification Board at the time the CDE renders services to the patient.
1. K046 is only eligible for payment when the record includes a flow sheet and/or a diabetic registry record meeting the published Standards of Care as defined in the Canadian Diabetes Association Clinical Practice Guidelines. The minimum required elements of the diabetes flow sheet include:
a. Laboratory parameters including:
i. Lipid profile (cholesterol, triglycerides);
ii. glycosylated haemoglobin (HgbA1C);
iii. albumin to creatinine ratio (ACR; and
iv. estimated glomerular filtration rate (eGFR) or Creatinine Clearance (CrCl)
b. Blood pressure;
c. Height, weight and body mass index (BMI);
d. Medications (including dosage);
e. Services related to prevention of diabetic complications;
f. Health promotion counselling and patient self-management support;
g. Evaluation and referral, as necessary, for dilated eye examination;
h. Foot examination; and
i. Neurological examination
2. K046 is not eligible for payment unless the record identifies any CDE performing the elements of the flow sheet.
1. In circumstances where the CDE is employed by facilities, organizations or persons other than the physician, such as public hospitals, public health units, Independent Health Facilities (IHFs), industrial clinics or long-term care facilities, K046 is not
eligible for payment.
2. For payment purposes, services rendered by the Certified Diabetic Educator (CDE) do not require the physical presence of a physician for direct supervision. It is required that the CDE performing services has the appropriate authorization from the applicable regulatory college, the CDE reports to the physician, and the services are rendered in accordance with accepted professional standards and practice.
3. K046 is payable in addition to K045.
Claims for K046 may only be submitted when the required elements of the service have been completed for the previous 12 month period.