Medical Billing Codes and Rules Session Two

1 May 2016 copies permitted for personal use only, commercial use is prohibited - Valley Medcom Billing Inc. 1 Medical Billing Codes and Rules Session Two Presented by: Cindy King - Valley Medcom Leader in Medical Billing Training in BC May 2016 copies permitted for personal use only, commercial use is prohibited - Valley Medcom Billing Inc. 2 Table of Contents Codes and Rules Facilitator Introduction Page 3 Consultations Page 4 Complete Physicals Page 5 Office Visits Page 6 Counseling Page 7 In Office Maternity Page 10 Home Visits Page 12 Call ins and After Hours Surcharges Page 12 Immunizations Page 18 Office Diagnostic Tests Page 19 Common Procedures Page 20 Misc Fee Codes Page 23 Emergency Care MH Certification GP telephone management GPSC) Page 25 Transports Page 25 Hospital Visits and LTC Page 26 Incentive Fees Page 30 Conferencing Fees Telephone services (GPSC GP and Specialist)

2 Planning and Assessment Fees Palliative, Complex, MH, Annual, CDM Deliveries Page 54 Surgical Assists and Anesthesia Page 57 ER Shifts (Urban and Rural) Page 59 Trauma Team Codes Page 62 ICBC and WCB Billing Page 64 Supplemental Information and Templates Page 67 May 2016 copies permitted for personal use only, commercial use is prohibited - Valley Medcom Billing Inc. 3 Facilitator Introduction Cindy King Owner and manager of Valley Medcom Billing Inc since 1992. Medcom is the largest Medical Billing service bureau in BC and has 5 main offices in BC (plus 3 satellite offices) providing in house and remote Medical Billing claims management, accounts receivable management and data entry for thousands of physicians and practitioners including PBF funding as well as Alternative Payment Billing for physician groups at a number of BC hospitals / Health Authorities.

3 Medcom has been successfully operating since the inception of electronic Medical Billing in BC, well over 25 years ago. Cindy is a workshop facilitator and trainer for offices and facilities around the province as well as providing internal audit services and Billing assessment reviews and Clean Up Action Plans . For 7 years she facilitated training sessions for Billing and Office Management to both the Rural and City Residents years 1 and 2 for the UBC Department of Family Practice. In addition, Cindy has held positions as a Health Care Trainer, Program Coordinator and Program Advisor for Stenberg College a Private Post-Secondary Institution for MOA, HSS and MLA programs for 5 years and provided many of the same services to a variety of other lower mainland Post-Secondary institutions.

4 Cindy has worked closely with the Fraser Health Authority in a consultant s capacity which included site assessments and training for Primary Health Care Organizations converting to blended funding and Billing training for staff and physicians for the Vancouver Coastal Health Authority Community Health Care sites. She also managed the UBC Family Practice Centre during the conversion from Fee For Service to Primary Health Care under the Primary Health Care Demonstration Project and was on board during the conversion from Clinicare to WOLF and paper to paperless. 2 years Valley Medcom also provides on going Billing support services for the Burnaby Division of Family Practice and is working with the Vancouver Division of Family Practice providing Billing support and training for their new A GP For Me Initiative.

5 Disclaimer: As you are now doubt aware Billing in BC is an ever changing set of Rules and Codes . At the time of printing, the Codes and Rules contained herein are up to date however it is incumbent upon the reader to ensure that they routinely check the MSP web site for changes to the MSC Fee Schedule and the bi monthly broadcast messages to ensure that this information is updated as necessary. In addition, information from the DOCTORS OF BC, GPSC and various sections will alert you to proposed and adopted changes as well. Welcome to the code and Rules Session by Valley Medcom Billing Inc! May 2016 copies permitted for personal use only, commercial use is prohibited - Valley Medcom Billing Inc. 4 Commonly Billed In and Out of Office Codes for GPs and Specialists CONSULTATIONS GP: 12110, 00110, 15310, 16110, 17110, 18110 In office 12210, 13210, 15210, 16210, 17210, 18210 Out of office 116 Applicable when GP has been asked to provide a consultation by a certified specialist for a Pt in acute or extended care or in the ER when a decision to admit has been made.

6 Intended for Pts that are terminal or very complicated. Claim no longer requires a note record explaining the Medical necessity of the consultation and the nature of the patient s problem(s) but this must be charted for audit purposes to validate the need for this fee item over a standard consult. Choice of Dx code is important and must support the criteria Please note: GP Consultations will not apply if the referred patient has been attended by the consulting practitioner or another practitioner in the same group during the preceding six months. Specialists may bill a limited consultation if supported by Medical necessity and a full consultation if it is a new problem, with a new referral, and completely unrelated to the previous consult. Specialists: Fee items are prefixed by specialist code Full Consult: Internal Med 310, Obstetrics 4010, Psychiatry 610, Pediatrics 510 etc Repeat or Limited Consult: Internal Med 312, Obstetrics 4012, Psychiatry 612, Pediatrics 512 etc Please note that consults are not payable when billed on the same day as ICU care (neither is continuing care exception for NICU Codes although initial call in is) IMPORTANT: Consultations apply when a Medical practitioner (GP or Specialist) in the light of his/her professional knowledge of the patient and because of the complexity, obscurity or seriousness of the case, requests the opinion of another practitioner competent to give advice in this field.

7 A consultation must not be claimed unless it was specifically requested by the attending practitioner. Please note that referrals from health care practitioners are accepted in certain circumstances depending on the reason for the referral and the practitioner s specialty. For example: midwife, for obstetrical or neonatal related consultations; oral/dental surgeon, for diseases of mastication; podiatrist for xrays, labs or foot related conditions. A history, exam, review of labs and findings (some or all) may be required to enable the attending practitioner to prepare and render a written report back to the referring physician advising them of the outcome of the assessment and indicating if care will continue for that referred Dx or be transferred back to the referring physician.

8 A copy of this letter must be kept in hard or electronic copy to support any audit. May 2016 copies permitted for personal use only, commercial use is prohibited - Valley Medcom Billing Inc. 5 When submitting the claim for the consultation the referring physician must be identified by MSP practitioner number. Do not use payee numbers which may be different, or MSC numbers which are not valid for Billing MSP claims. Another important thing to note is that a referral must be associated with a specific physician/MSP practitioner number. For example: BCCA is not a valid referral but Dr. Smith pract # 62345 at the BCCA is. If the Pt sees Dr Jones instead but for the same Dx then that is acceptable. Important: Consultations are not payable for transfer of care at the end of a shift or between physicians who commonly work together UNLESS the consulting physician is a GP specialist and asked to see the Pt in light of his additional expertise and interest.

9 MSP is vigorously auditing this right now. 3333 While MSP is not scrutinizing and matching up the 3333 no charge referral for all consults billed they will do so for claims that go into manual adjudication. That means that you are on your honor to ensure that you have a valid referral before Billing the consultation. Please also keep in mind that the same goes for the Pt you refer to a specialist. If you do not submit the 3333 there is a chance that the consultants claim for a consult will be refused. UPDATE during 2014 MSP has started scrutinizing and matching the 3333s to consultations. The lack of Billing the 3333s, common with ER physicians, has recently resulted in audits against specialists. You do not want to be responsible for triggering an audit as it will not be appreciated and you will also be involved and required to determine if you saw the Pt and referred them and just forgot to advise MSP.

10 The 3333 remains valid for 6 months from the date of the consult billed, not the date the 3333 was billed. It is not necessary to hold 3333 claims, they will be retained in MSP s system indefinitely until the consult is billed. Re-referrals do not necessarily require a face-to-face encounter. It is at the discretion of the referring doctor to grant a re-referral for a new or associated problem, or the consultant can agree to assess the Pt as a follow up (GP follow up code , vs specialist, if not within 6 months of the initial consult) or limited consult (if still within 6 months of the initial consult). Special Circumstances for Specialists: The odd time a referring doctor number is not available or is no longer valid. These numbers below are valid for an initial consult and are also valid for any follow ups within 6 months of your consult.