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K144 – Chronic disease shared appointment - 6 to 12 patients per unit

OHIP Consultations and Visits Code — CONSULTATIONS AND VISITS · Schedule of Benefits

Chronic disease shared appointment is a pre-scheduled primary care service rendered for chronic disease management, to two or more patients with the same diagnosis of one of the diseases listed below, that consists of assessment and the provision of advice and information in respect of diagnosis, treatment, health maintenance and prevention. Each patient must have an established diagnosis of one of the following chronic diseases: a. Diabetes b. Congestive Heart Failure c. Asthma d. Chronic obstructive pulmonary disease (COPD) e. Hypercholesterolemia f. Fibromyalgia The physician must be in constant personal attendance for the duration of the appointment session, although another appropriately qualified health professional may lead parts of the educational component of the session (for example, a diabetic educator or nurse). In addition, a clinically appropriate assessment must be rendered to each patient by the same physician as a component of the chronic disease shared appointment. This service has the same specific elements as an assessment.
The physician must record on the patient's permanent medical record or chart the time when the insured service started and ended for unit-based services.

OHIP diagnostic codes: Diabetes, Congestive Heart Failure, Asthma, Chronic obstructive pulmonary disease (COPD), Hypercholesterolemia, Fibromyalgia

Unit means ½ hour or major part thereof - see General Preamble , to for definitions and time-keeping requirements.

The service is only eligible for payment when: a. the appointment is pre-scheduled; and b. each patient regularly visits the physician or another physician in the same physician group for management of their chronic disease.

Chronic disease shared appointment rendered the same day as an additional assessment by the same physician to the same patient is not eligible for payment unless there are clearly defined different diagnoses for the two services.

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