General Practice BILLING GUIDE - British Columbia Medical ...

A GP SERVICES COMMITTEE INCENTIVES
3. COMPlEx CARE MANAGEMENT FEES (14033 AND 14039)
The GP Services Committee has received considerable feedback expressing concerns
about the structure of the original complex care fee Options One and Two. Many
GPs feel that it is too complex, and others have expressed concern that care provided
subsequent to the Option Two annual block visit fee is not tracked and will not
capture care provided.
In response to this feedback, the GP Services Committee has revised the complex care
fee, effective January 1, 2008. The revised fee combines the best elements of the
initial two options to streamline billing and still appropriately compensate GPs for the
management of these complex patients.
This fee item is designed to compensate general practitioners for the extra time
required to provide planned care to more complex patients residing in their homes or
in assisted living (excluding care facilities).
Under the revised complex care management fees, there is only one billing option
for the planning and provision of care for eligible patients over the course of the
calendar year:
• Fee item G14033 provides compensation for the creation of a complex care
plan for eligible patients; those with two qualifying co-morbidities. This fee of
$315 is payable once per calendar year for the provision and monitoring of the
complex care plan during that calendar year;
• Provision of care for eligible patients will be billed on a standard fee-for-service
basis. Face-to-face visits between the GP and patient are required using the
appropriate MSP fee code.
• Additionally, once a GP/FP or practice has determined a patient is eligible for a
complex care plan and has created and has successfully billed for this plan,
they may access a new complex care follow-up management fee under fee
item G14039. These fees compensate the GP/FP or practice for two-way
telephone or email communication with the patient or the patient’s medical
representative. These fees are paid at $15 for up to a maximum of four
services per calendar year.
Due to the time, intensity, and complexity of creating the complex care plan, GPSC has
determined that a maximum of five complex care management fees can be billed by a
GP per calendar day. Upon application, an exemption may be granted by GPSC under
some circumstances; e.g., GP/FPs electing to dedicate a half-day for practice meetings
with complex care patients. These applications must be in writing and must include
the specifics of the reasons for requesting an exemption.
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GENERAL PRACTICE BILLING GUIDE