Specialists in the blocs of Internal Medicine, Neurology, Rheumatology, Cardiology, Gastroenterology, Nephrology, Medical Genetics, Physical Medicine, Malignant Disease Specialists, Radiation Oncology, Psychiatry, General Surgery, Cardiac Surgery, Orthopaedic Surgery, Vascular Surgery and Thoracic Surgery may claim Tariff 8595 Consultation – Unassigned Patient.The tariff is listed on the blocs’ visit pages (Section “A” of the Physician’s Manual) under the heading Hospital Care, and is described as follows:
- “Unassigned patient” means a patient who requires assessment by a (Specialist) who has not rendered a Complete History and Physical Examination (tariff 8540) or Consultation service (tariff 8550 or tariff 8595) to that patient within the last twelve (12) consecutive months.
Rules of Application 7 to 10 inclusive apply.
(Note: Psychiatrists please refer to your visit page for the specific Psychiatry definition)
Manitoba Health and Doctors Manitoba AGREE to the following interpretations respecting Tariff 8595:
- Tariff 8595 may be claimed with respect to patients:
- who present for assessment at an emergency department, regardless of whether or not an admission to hospital follows the consultation, or
- who are registered bed patients formally admitted to hospital.
- Tariff 8595 may not be claimed for patients who present at the out-patient department/clinic or a physician’s office.
- An “Unassigned Patient” is determined solely by whether the specialist has rendered a “Complete” (Tariff 8540) or “Consultation” (Tariff 8550 or 8595) service in the past twelve months to the patient. The fact that the specialist may have rendered other procedures or services, e.g. regional examinations, subsequent visits or hospital care services during the previous twelve months is irrelevant.
- The consultation must comply with Rules of Application 7-10.
- Tariff 8595 may be claimed for the same patient on the same day bymultiple specialists*.
* Manitoba Health and Doctors Manitoba DO NOT agree to the following interpretations respecting Tariff 8595.
It is Manitoba Health’s internal policy that Tariff 8595 may be claimed for the same patient on the same day, only when the specialists are in different blocs of practice. Where more than one specialist in the same bloc of practice sees the same patient on the same day, it is Manitoba Health’s policy that the specialist whose claim is first received by Manitoba Health will be paid. The Tariff 8595 claims of the other specialist(s) will be downgraded to Tariff 8550.
It is Doctors Manitoba’s position that Tariff 8595 may be claimed for the same patient on the same day by multiple specialists in the same OR different blocs of practice.
If any of your claims under Tariff 8595 have been downgraded in accordance with Manitoba Health’s internal policy, please contact us.
Updated: November 2016