K045 – Diabetes management by a specialist
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
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.
When to Use
- Use K045 once per 12-month period for patients with diabetes who are under your ongoing specialist care and have received a comprehensive annual review.
- Use K045 when you have completed the full suite of CDA-mandated assessments, including foot/neurologic exams and ACR testing, that go beyond a standard A005 or A007 assessment.
Common Pitfalls
- Billing K045 without explicit documentation of the foot and neurologic examination, which are mandatory audit requirements for this specific code.
- Attempting to bill K045 more than once in a 12-month rolling period, as this is a management fee intended for annual comprehensive review.
- Failing to document the offer of a referral for a dilated eye exam, which is a specific, non-negotiable requirement for K045 eligibility.
Billing Tips
- Always append K046 to your K045 claim if your office utilizes a multidisciplinary diabetes team, as this provides an additional premium for the same patient encounter.
- Maintain a dedicated diabetes flow sheet in the EMR to ensure all six mandatory CDA elements are captured in one place, simplifying the audit trail for K045.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
ManagementFee
Assessments
A flow sheet and/or a diabetic registry record must be completed for the previous 12 month period and maintained in the patient's permanent medical record. The record must document that all of the CDA required elements have been provided 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 self-management support; - d. Albumin to creatinine ratio (ACR); - e. Discussion and offer of referral for dilated eye examination; and - f. Foot examination and neurologic examination.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.