General Practice BILLING GUIDE - British Columbia Medical ...

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A GP SERVICES COMMITTEE INCENTIVES The clinical action plan is developed through interviewing the patient and family members and must include conferencing with other health care providers. This does not require face-to-face interaction in all cases. It may require organizing and reviewing appropriate laboratory and imaging investigations, administration of other types of testing as clinically indicated (e.g., Beck Depression Inventory, MMSE, etc.), provision of degrees of intervention, or “no CPR” documentation. The general practitioner will communicate the clinical action plan to the patient, other health care providers, and family members or others involved in the provision of care, as appropriate. The care plan must be recorded in the chart and include the following information: • patient’s name • date of service • diagnosis – V15 (frail elderly) – V28 palliative/end-of-life care – mental illness (enter ICD-9 code of qualifying illness) – patients of any age with multiple medical needs or complex co-morbidity (enter ICD-9 for one of the major disorders) • reason for need of clinical action plan • health care providers with whom you conferred and their role in provision of care • clinical plan determined, including tests ordered and/or administered • patient risks based on assessment of appropriate domains (list of co-morbidities and safety risks) • list of priority interventions that reflect patient goals for treatment • what referrals will be made, what following about has been arranged (including timelines and contact information), as well as advanced planning information Restrictions • This payment is not payable to the same patient on the same date of service as the facility patient conference fee (fee item 14015). • This payment is not payable to physicians who are employed by or who are under contract to a facility who would otherwise have attended the conference as a requirement of their employment or contract with the facility, or physicians working under salary, service contract, or sessional arrangements. • A medically required visit is billable in addition if it does not take place concurrently with conferencing. Start and end times for the conferencing component are required. GENERAL PRACTICE BILLING GUIDE A/13
A GP SERVICES COMMITTEE INCENTIVES This fee covers the two-way collaborative conferencing with other providers in the development of a clinical action plan. The transmission of information in a referral process does not qualify. 2.2.1 hOW TO BIll Submit the new fee item 14016 through the MSP claims system under the patient’s PHN. The claim must include ICD-9 codes V15, V58, or the code for one of the major disorders (see table 1 below). You must put the date and the start and end times in the claim for the conferencing fee only. If you are billing for a medically necessary visit as well, submit the visit fee for the same date but either do not put in a time, if it is weekday daytime visit, or make sure the time is either before or after the conferencing fee, not the same time, if using an outof-office hours visit fee code. When charting information to support this fee, note the details of the plan, as outlined above, and when the patient will be reassessed. (See documentation template at end of this section.) There are times where the development of the plan and the involvement of other health care providers may require time over two days, and each day would then have the fee billed with a different date and time of service, along with documentation of this in the chart. 2.2.2 FREqUENTly ASKED qUESTIONS 1. What is the maximum number of payments allowed per patient? A maximum of 4 units (60 minutes) per day, to a maximum of 6 units (90 minutes) per calendar year. 2. Is this fee billable if a claim for the facility patient conferencing fee was also made for the patient on the same day? No. 3. Can this fee be billed the same day as a CDM fee? Yes. For those patients who have one of the conditions covered under the CDM fees, and where it is appropriate to bill the CDM fee, it is acceptable to bill them on the same day provided all other requirements are met. 4. Can this fee be billed the same day as a complex care fee? Yes, for those patients who have two of the conditions covered under the complex care fee if all other requirements are fulfilled, they may both be billed on the same day. A/14 GENERAL PRACTICE BILLING GUIDE
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B WORKSAFEBC GP FEES Fee Code Descr
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B WORKSAFEBC GP FEES Fee Code Descr
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GENERAL PRACTICE BILLING GUIDE
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C UNINSURED SERVICES A00073 A Medic
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C UNINSURED SERVICES NOTE: Physicia
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GENERAL PRACTICE BILLING GUIDE
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APPENDIX i FORMS FOR THE GPSC INITI
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APPENDIX ii OTHER TOOLS TO SUPPORT
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APPENDIX iii DIAGNOSTIC CODES QUICK
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APPENDIX iii DIAGNOSTIC CODES QUICK
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