This item may only be billed after one year of care has been provided and the patient has been seen at least twice in the preceding 12 months or the patient has received 12m of “guideline/FSFP” care. Other flow sheets can be used if they are consistent with the BC clinical guidelines for diabetes, heart failure, and/or essential hypertension management. This program is to the usual process of random audit through the Ministry of Health’s Billing Integrity Program. Therefore, it is important that you keep all of your completed patient flow sheets on file. CDM
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This item may only be billed after one year of care has been provided and
the patient has been seen at least twice in the preceding 12 months or
the patient has received 12m of “guideline/FSFP” care.
Other flow sheets can be used if they are consistent with the BC
clinical guidelines for diabetes, heart failure, and/or essential
hypertension management.
This program is to the usual process of random audit through the
Ministry of Health’s Billing Integrity Program. Therefore, it is
important that you keep all of your completed patient flow sheets on
file.
CDM
• The "Routine or periodic physical examination” on the well patient with no underlying medical conditions is not covered by MSP.
• For patients with chronic illness where guideline informed care recommends periodic complete examinations, such as with diabetes, CHF, etc., a CPX is billable. (2 x yr with note)
• Healthy patients still need periodic partial examinations as per prevention/screening recommendations.
Prevention Guidelines
Prevention Guidelines
• Colorectal Cancer hemoccult test q1-2 yrs starting age 50
• Mammogram/Pap smears
• Hypertension screening
• Hyperlipidemia screening, males>40, female>50 or if risk sooner
• DM screening, fbs q3yrs >40 yrs, sooner if risk
• ASA discussion if at risk
• Smoking cessation
• Diet modification
• Exercise recommendations if cvs or dm risk
Prevention Fee (14066)
• Smoking…(use icd9 code) 786
• Physical inactivity…785
• Medical obesity..783
• Unhealthy eating…783
• In high risk patients a review every year may be appropriate and so this may be billed on the same patient every year.
Billing tip: Keep an ongoing yearly list to max out billings, 100/year only.
Commercial Driver exams and exams for 80+ years old must pay
privately for exam (fee code A00055 if complete exam, A00056 if
“partial examination” only)
Those for “Drivers with Disability” (eg. Diabetes) may bill part to
OSMV and part to patient for full BCMA value o 96220 – Driver’s Medical Examination Report (DMER) = $75 to OSMV
o 96221 – Diabetic (professional) Driver Report – stand-alone = $75 to OSMV
o 96222 – Diabetic (professional) Driver Report plus DMER = $30 to OSMV (for
total $105)
BCMA rate set April 1 each year – balance bill difference to patient accepted by
OSMV and MSP as this is not a “medically necessary” service.
5
Drivers Medical examinations
2013 5 new initiatives
• Frail complex patients not meeting CCF criteria.
• Unattached “1st visit” high needs complex patients.
• Telephone calls to patients.
• Telephone calls to facilities.
• New hospital initiatives.
Attached practice 14070
• You confirm the doctor patient relationship, by billing a zero sum
billing code --14070 --yearly to MSP.
• You provide FSFP services and will for the duration of the calendar
year.
• Membership to a division not required, but you need to contact
your local division to share your contact information and your
desire to participate with the initiatives to develop community-
specific supports as you are able.
Confirming doctor patient relationship.
As your family doctor, my practice team and I will:
• Provide you with the best care that we can
• Coordinate any specialty care that you need
• Offer you timely access to care within the best of our ability
• Maintain an ongoing record of your health
• Keep you up-to-date on any changes to the services offered at our office
• Communicate with you honestly and openly to address your health care
needs.
Confirming doctor patient relationship.
As my patient, I ask that you:
• Seek your health care from me and my team whenever possible
• Identify me as your doctor if you have to visit an emergency facility or other
health care provider, so they can provide me with information about your
treatment for your medical record
• Communicate with me honestly and openly so that we can best address your
health care needs.
Submit fee item 14070 GP Attachment Participation Code
using the following “Patient” demographic information:
PHN#: 975 303 5697
Patient Surname: Participation
First name: Attachment
Date of Birth: January 1, 2013
ICD9 code : 780
How to bill for “Attached practice” fee code 14070
NO need to call in each patient
Can be done face-to-face, by letter or other communication,
such as posting a standardized pamphlet in office and
examination rooms provided by the GPSC.
Supportive materials (posters, brochures) are available from the
GPSC website (www.gpscbc.ca)
Attached practice 14070
1) Frail complex patients not meeting CCF criteria. New expanded CCF billing 14075.
• Attached practice.
• All patients with CSHA Clinical Frailty Scale score of 6 or more who do not already qualify for CCF.
• 14033 still available for those not participating in attachment/division initiative.
S H A F T
• S hopping
• H ousekeeping
• A ccounting
• F ood
• T ransport
Help with all...
2) Telephone calls to patients 14076
• Attached practice.
• $15 fee , max 500/year.
• Not for appointments or referrals or refill of Rx.
• New fee..phone call only..doctor/patient..not email.
• May be delegated to another College-certified healthcare professional, not
moa.
• 14079 still applies..telephone or email.
• Intent is to avoid a visit, to practice or WIC or ER. If office visit or house call
takes place the same day the 14076 will be rejected.
3) Telephone calls to facilities and community 14077
• Attached practice. Any patient for whom FP is MRP.
• Replaces 14015, 14016, 14017 codes. Therefore must include start and end time on the billing submission and should last greater portion of 15 minutes in duration.
• $40/15min for phone call to a facility or community. Ex: calling ER to give information on a patient being sent down, receiving phone calls from hospital re: admission/updated condition/discharge.. Calls from community by qualified personnel, calls to a nursing home > 8 minutes (otherwise bill 13005) ..
• Either side may initiate.
• Max 2/calendar day, up to max 18/calendar year per patient
6 phone call fees
14016/14077 Community Patient Conferencing, payable per 15 minutes or greater portion thereof. Consult with specialist/other qualifier (ex: home care or palliative care nurses, social workers)
1. Frail Elderly; (70yrs+) Diagnostic Code V15 2. Palliative Care; Diagnostic Code V58 3. End of Life; Diagnostic Code V58 4. Mental Illness; Appropriate Mental Health Diagnostic Codes
14079 (max 5/ 18months post billing) payable telephone/email
once 14033 (CCF) billed
or payable once 14043 (Mental Health) billed,
or payable once 14053 (COPD/CDM) is billed,
or End of life phone/email advice 14063 billed.
13005 Advise about a patient in community care. This fee is billable when an allied health professional has contact with the FP.
14018 General Practice Urgent Telephone Conference with a Specialist
phone call fees…
4) Unattached high needs/complex patient Attachment Fee 14074
• $200, in addition to a visit.
• Commit to at least one year of care.
• Target populations..
– frail of any age when accepted into practice or into residential care..
– significant cancer..
– severely disabled in the community..
– mental health and addictions..
– mother/baby (during pregnancy and up to 18m) dyads..
14016 coordination of care for community based patients 14077 facilty phone call $40 max 18 per patient per yearconferencing with 1 other health care provider 14076 $15 phone home for medical problem if patient attacfhed max 500/yr$40 per greater portion of 15 minutes/max 4 per day/ 6 per year per patient 14075 CCF+ ++
14074 unattached to attached bonus if referreduse ICD9 V15...frail elderly, 70yrs plus
V58…palliative care, end of life care 14018 urgent phone consult with specialist ..(no visit to follow in 24hrs to spec/er) XXX…complex mental illness 14079 $15 (max 5/18m) > CCF,COPD,PallIATIVE,MENTAL HEALTH YYY…complex comorbidity, 3 serious diseases 14016 $40 coordination of care
13005 ~$15
CDM $125 DM (14050)/CHF (14051)/COPD (14053)..BP (14052) $50 . DM, COPD, and CHF may all be billed in same year, BP can be combined with COPD
Palliative Care 14063 $100 (+0100 if >30mins. or 0120 if >50mins.)…