General Practice BILLING GUIDE - British Columbia Medical ...

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A GP SERVICES COMMITTEE INCENTIVES BILLING: You are eligible in this case to bill 17100 for the office visit. You are also eligible to bill the appropriate units of 14016 for the time following the examination spent organizing the care plan with other health care providers and with the patient and family. Date Time # of Services Fee Code Diagnostic Code MM/DD/YY 17100 401 MM/DD/YY 1100 – 1125 2 14016 V15 Example #4: Ms. W presents with her 14-year-old son Billy who has ADHD. There has been an incident at school where Billy has been verbally aggressive with a few teachers, including threatening their safety. You find in further questioning that Billy has been defiant in taking his medications, and it has been two years since he was reviewed by the child psychiatrist. Over the past year, Billy has grown 8 inches and gained 40 lbs. He is showing other physical signs of advanced puberty. You discuss with them both the role of growth spurts on medication dosage, as well as the hormonal impact from puberty on moods. Billy admits to being very moody and afraid of the mood swings he is experiencing. You spend 25 minutes counseling him in the presence of his mother about coping with these aspects of his illness and puberty. You agree to immediately contact child psychiatrics to discuss adjustments to medications and referral to the youth and adolescent mental health team to access urgent counseling so that Billy can return to school. This is further discussed with Ms. W and her son prior to leaving the office. The time of the visit was 3:25 pm, with contact with the other health team members from 3:50 pm to 4:15 pm. BILLING: You are eligible in this case to bill 0120 for the counseling visit with Billy. You cannot bill for Ms. W as she was not seen for her own medical issues. If she was, you can only bill the office visit for her and the counseling for Billy if they were seen separately and this must be noted on the claims. You are also eligible to bill the appropriate units of 14016 for the time following the examination spent organizing the care plan with other health care providers and with the patient and family. Date Time # of Services Fee Code Diagnostic Code MM/DD/YY 00120 314 MM/DD/YY 1550 – 1615 2 14016 314 GENERAL PRACTICE BILLING GUIDE A/19
A GP SERVICES COMMITTEE INCENTIVES Example #5: Mrs. M is 81 years old and is brought in by her daughter. After Mrs. M is in the examining room, her daughter asks to speak with you briefly before you see her mother. At this time she advises you that she is concerned her mother is not taking her medications correctly as they are not running out at the same time and she notices her mother seems to be off balance at times. You thank her and go in to see Mrs. M and notice that all her medications are lined up on the examining table. She comments that she thinks the pharmacist has shorted her on her blood pressure medications as she has run out of them before her other medications. When you question her, you ask if she has noticed any balance troubles and she remarks that on occasion she finds when she gets up after sitting or lying down, she feels very light-headed. Her blood pressure is found to be 100/60 with a pulse of 90. You ask her if she may occasionally take her morning blood pressure meds twice and she admits that may be a possibility. You ask if you can bring in her daughter to help set up a plan to sort out whether her blood pressure is low because of this or if she needs to have her medications adjusted. She agrees, and her daughter comes in. You discuss the situation and the daughter and Mrs. M agree that you will contact the pharmacist and relay the plan that they should set up a blister pack of all medications for two weeks and that the daughter will go in a few times over the next two weeks to check her blood pressure with a home monitor and come back to the office to review the levels and determine if her medications need to be adjusted. The visit time spent with the daughter in the room and the subsequent phone call to the pharmacist is 20 minutes. BILLING: In addition to the office assessment, this is eligible for the 14016 as a plan to monitor, review, and manage is developed with the patient and her daughter, and required the involvement of the pharmacist. Date Time # of Services Fee Code Diagnostic Code MM/DD/YY 18100 V15 MM/DD/YY 1550 – 1610 1 14016 V15 Example #6: Mrs. B is 84 years old. She and her daughter come in to see you at the end of the day. Mrs. B and her daughter have noticed that Mrs. B has difficulties with her balance and this is causing some safety concerns. The daughter has temporarily moved in with her mother but is scheduled to go out of the country in a few weeks on business. You examine Mrs. B and find her vitals stable and no obvious cause for these problems. You discuss options and they are agreeable to having the home care and elder A/20 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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General Practice BILLING GUIDE - British Columbia Medical ...

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