General Practice BILLING GUIDE - British Columbia Medical ...

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A GP SERVICES COMMITTEE INCENTIVES Please contact the Department of Professional Relations at the BC Medical Association with enquiries regarding the fees contained in this section. 1. ChRONIC DISEASE MANAGEMENT (CDM) PAyMENTS This program is an expansion of the full-service condition-based payments for family practice introduced in 2003. The purpose of the condition-based payments is to improve patient care through recognition that additional work may be required over the year beyond the office visit so that patient care meets the established clinical guidelines. Flow sheets have been developed to improve tracking of patient-specific information and are to be used when providing care to patients covered under the condition-based incentives. While use of official Guideline and Protocol Advisory Committee (GPAC) flow sheets is not mandatory, the same basic information must be included in any form of flow sheet (electronic or paper) that is utilized. This bonus is billed in addition to any other fees, including complex care fees, and office/hospital/ long-term care visits incurred by usual patient care, provided all other requirements are fulfilled. The program has been enhanced through an increased annual bonus for provision of clinical guidelines-based diabetes and congestive heart failure care and the introduction of a bonus payment for clinical guidelines-based hypertension management. Payments are made in recognition of the work that has been done and is not made in advance of the work being done. NOTE: See the payment schedule at the end of this section for the dollar value of each bonus payment. Eligibility These payments are available to all general practitioners who have a valid BC Medical Services Plan (MSP) practitioner number (registered specialty 00), except those who have billed a specialty consultation fee in the previous 12 months, and: • the majority of whose professional activity is in full-service family practice, and • who have been the major provider to the patient of longitudinal general practice care over the preceding year, and • who have provided the requisite level of guideline-based care. Care for patients covered by other provinces who are temporarily in BC is not eligible for bonus payments as their regular physician is in the other province. If the patients stay in BC and obtain coverage under the Medical Services Plan, then their care becomes eligible for the program. In a few border communities a BC physician may provide the majority of care for an Alberta or Yukon patient, and care for these patients is eligible. GENERAL PRACTICE BILLING GUIDE A/1
A GP SERVICES COMMITTEE INCENTIVES 1.1 DIABETES (14050) For the provision of guideline-recommended care for all diabetes, family physicians may apply for the diabetes CDM bonus using fee code 14050 and diagnostic code 250. This fee is billed annually on the anniversary date of the first billing. The patient does not need to be seen on the date the CDM is billed as it is a management fee. Note that the treatment of hypertension is part of this guideline, so the CDM for hypertension may not be billed in addition to the 14050. However, if the patient also suffers from congestive heart failure, the bonus fee 14051 may be billed as well. 1.2 CONGESTIVE hEART FAIlURE (ChF) (14051) For the provision of guideline-recommended care for all congestive heart failure patients, general practitioners apply for the CHF CDM bonus using fee code 14051 and diagnostic code 428. This fee is billed annually on the anniversary date of the first billing. The patient does not need to be seen on the date the CDM is billed as it is a management fee. Note the treatment of hypertension is part of this guideline, so the CDM for hypertension may not be applied for in addition to the 14051. However, if the patient also suffers from diabetes, the bonus fee 14050 may be billed as well. 1.3 hyPERTENSION (14052) For the provision of guideline-recommended care for all hypertension patients for the previous year, general practitioners apply for the hypertension CDM bonus using fee code 14052 and diagnostic code 401. This fee is billed annually on the anniversary date of the first billing. The patient does not need to be seen on the date the CDM is billed as it is a management fee. Note that the treatment of hypertension is part of both the diabetes and CHF guidelines, so the CDM for hypertension may not be applied for in addition to the 14050 or 14051. 1.4 BIllING PROCEDURE The chronic care incentive bonuses may be applied for once continuity of monitoring the patient’s course of care according to BC clinical guidelines has been established, that is, once the minimum requirements outlined below have been completed. Condition-based bonus claims are submitted through the MSP claims system the same way you would submit an MSP fee-for-service claim. The submission must include the relevant ICD-9 code (250 for diabetes mellitus; 428 for congestive heart failure; 401 for hypertension). A/2 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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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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