K046 – Diabetes team management
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This is an annual fee payable to a specialist in internal medicine or endocrinology for the comprehensive team-based 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). K046 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.
When to Use
- Use K046 as an annual management fee for patients with diabetes when you are an endocrinologist or internal medicine specialist coordinating care with a CDE.
- Submit K046 once every 12 months only after the comprehensive diabetes flow sheet requirements have been fully met and documented.
Common Pitfalls
- Billing K046 without explicit documentation of the CDE's involvement in the patient's care plan will lead to audit recovery.
- Claiming K046 before the 12-month interval has elapsed since the previous K046 submission is a common cause for rejection.
- Failure to include all mandatory flow sheet elements, specifically the ACR and eGFR, will invalidate the claim during a ministry audit.
Billing Tips
- Always pair K046 with K045 on the same claim to maximize the annual reimbursement for the comprehensive management service.
- Ensure your EMR template for K046 automatically pulls in the required lab parameters and physical exam findings to prevent missing mandatory data points.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
ManagementFee
Assessments
The record must include 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: - Laboratory parameters including: - Lipid profile (cholesterol, triglycerides); - glycosylated haemoglobin (HgbA1C); - albumin to creatinine ratio (ACR; and - estimated glomerular filtration rate (eGFR) or Creatinine Clearance (CrCl) - Blood pressure; - Height, weight and body mass index (BMI); - Medications (including dosage); - Services related to prevention of diabetic complications; - Health promotion counselling and patient self-management support; - Evaluation and referral, as necessary, for dilated eye examination; - Foot examination; and - Neurological examination
The physician must document the services rendered by the CDE. The physician must provide such documentation to the ministry, if requested.
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