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..

• Need referral source.

Unattached Complex/High Needs Patient Attachment fee 14074

Referral Sources

• Acute Care: ER and Admitted

• Mental Health/Substance Abuse Workers/Clinics

• Home and Community Care

• BC Cancer Agency or regional centers

• Public Health

• Medical director of nursing home.

• Colleagues.. To be determined..? Thru DoFP

• Local Division

Patients cannot self-identify

• If there is a new FP taking over a practice of a doctor who is retiring/leaving,

the new FP is not eligible to bill G14074 on any existing patients of practice

as all practice infrastructure is already in existence, it is a transition only.

• If there is no FP to take over a practice of a doctor who is retiring/leaving

and the leaving FP asks other FP(s) to take on these complex patients, GPSC

has agreed that this is an acceptable referral. FPs accepting transfers of

these patients will be able to bill the G14074 for eligible

patients. Alternatively, the patients could be referred to accepting FPs

through the locally determined unattached patient attachment process

Attachment fee 14074

• The referrals do not need to be a lengthy written referral although it would be good to get the available

background information to the accepting FP up front, rather than expecting the MOA to chase

everything down.

• However, the referral must come directly from the source, so it is not just the ER telling the patient they

need an FP and give them a list of who is accepting new patients.

• GPSC is asking the local Divisions to discuss and develop a referral process that works for their

membership. The DoFP could even decide on something as simple as the ER/Hospital Discharge

Planning Team sending a list of patients (with PHN, contact info and diagnoses) as the patients are

referred to specific FPs from the list of FPs who have agreed to take these complex/High-needs patients

on.

• There is no need to submit any electronic referral through MSP. The referral source must be

documented in the new patient chart.

Attachment fee 14074

• 14077 replaces the 14015, 14016 & 14017. More flexibility as no patient diagnosis

restrictions or location restrictions as there were in the original 3 codes. 14077 can be

billed for a phone call at any stage of admission to Acute Care or any facility or

community. Time requirements are the same - 15 minutes or greater portion

thereof. Must put start and end times in bill.

• 14077 billing if FP is participating in Attachment and has submitted 14070 participation

code. If FP is not participating, then only has 13005 available regardless if simple/brief

or longer conferencing.

• Fax or brief advice - use 13005.

Telephone calls to facilities 14077 vs. 13005

5) Hospital visits.

• 25% increase on 13008 & 00127 effective April 1, 2013

• Assigned Inpatient Care Network Initiative of $2100 per quarter for FPs

who maintain active privileges to care for their own patients in-hospital

new fee code 14086.

• Unassigned Inpatient Care Fee of $150 per patient. This fee will be

limited to FPs actively participating in the Unassigned Inpatient Care

Network initiative new fee code 14088.

• Not payable to physicians who are employed by or who

are under contract to a facility and whose duties would

otherwise include provision of this care; and

• Not payable to physicians working under salary, service

contract or sessional arrangements whose duties would

otherwise include provision of this care.

5) Hospital visits.

The benefits of attachment bill 14070 1st

14070

14074

14075

14076

14077

Unattached >>> attached ($200)

CCF +++ ($315)

ET call home

($15x 500/doctor/yr)

Call facility

($40 x18/patient/yr)

complex care fee billable by most responsible doctor

billable any time once per calender year

code value cdm bonus fee still billable

14033 $315 plus appropriate 0100/0101 14079 $15 (max 5/18m) > CCF,COPD,PallIATIVE,MENTAL HEALTH

visit use appropriate unique ICD9 code for CCF phone call phone/e-mail, by physician only

unique ICD9 codes for either complex care feeH250 CHF DM

N414 Chronic neurodegenerative Ischemic heart disease H430 CHF Cerebrovascular DiseaseN428 Chronic neurodegenerative CHF H585 CHF Chronic Kidney DiseaseN250 Chronic neurodegenerative DM H573 CHF Chronic Liver DiseaseN430 Chronic neurodegenerative Cerebrovascular Disease D430 DM Cerebrovascular DiseaseN585 Chronic neurodegenerative Chronic Kidney Disease D585 DM Chronic Kidney DiseaseN519 Chronic neurodegenerative Chronic Resp Disease D573 DM Chronic Liver Disease

N573 Chronic neurodegenerative Chronic liver Disease C585 Cerebrovascular Disease Chronic Kidney Disease

I573 Ischemic heart disease Chronic liver Disease C573 Cerebrovascular Disease CLD liver disease

I428 Ischemic heart disease CHF R414 Chronic Resp Disease Ischemic Heart Disease

I250 Ischemic heart disease DM R428 Chronic Resp Disease CHF

I430 Ischemic heart disease Cerebrovascular Disease R250 Chronic Resp Disease DM

I585 Ischemic heart disease Chronic Kidney Disease R430 Chronic Resp Disease Cerebral Vascular Disease

K573 CKD Chronic Liver Disease R585 Chronic Resp Disease CKD

phone/conferencing fees Attachment + phone calls14070 attachment code yearly "0" sum

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.)…

Prevention Fee $50 bonus (14066) + 0100/0101/any age/medical obesity (783) /unhealthy eating (783) / physical inactivity(785) /smoking(786)

GP Mental Health Fees

14043 $100 GP Mental Health Planning Fee >>>> >>>>> >>>>> bill appropriate 0100/0120 in addition to 14043 if visit > 30 minutes

14079 $15 phone call 5/18m 30 minutes visit, bill 14043 only

33-50 minute visit, bill 0100+14043

once patient b illed 4* 0120 for the calender year, may bill 4 additional following fee codes per year >50 minutes visit, bill 14043 +0120

14044 4/yr (=00120 $) GP Mental Health Care Management fee (ages <50)

14045 4/yr (=00120 $) GP Mental Health Care Management fee (ages 50-59)

14046 4/yr (=16120 $) GP Mental Health Care Management fee (age 60 - 69)

14047 4/yr (=17120 $) GP Mental Health Care Management fee (age 70 - 79)

14048 4/yr (=18120 $) GP Mental Health Care Management fee (age 80+)

•13228 weekly/per patient for hospital visit /associate status 13070 2nd billing if WCB billed 1st & msp issue arises

•13339 1st patient of the day in addition to 13228 13075 2nd billing if ICBC billed 1st & msp issue arises

•For younger patients with no pre-existing CVD or other

significant risk factors (hypertension, smoking, family history of

CVD, target an A1C below 7% (especially if it can be easily

achieved).

•For older patients (> 50 years), with a longer duration of

diabetes (> 15 years), target an A1C of ~7%. This target will

avoid the potential downsides of intensive therapy (such as

hypoglycemia and possible increased CVD risk), while still

providing protection against microvascular disease.

•For patients with significant comorbid illness and a limited life

expectancy, target a higher A1C 7.5-8% or higher.

DM Rx algorithm

Self-Titration of Insulin

• Your target fasting blood sugar level is between 7-8 mmol/L

• You will inject 10 units of insulin each day..for 3 evenings.

• You will continue to increase by 1 unit every evening (or every 2-3 evenings) until your blood sugar level is between 7-8 mmol/L before breakfast

• Do not increase your insulin when your fasting blood sugar is 7 mmol/L

Insulin Dosage Instructions..for patient

* Insulin

Initiation

Issues

Gerstein HC, et al. Diabet Med 2006;23(7):736–42

Canadian Diabetes Association Clinical Practice Guidelines.. Can J Diabetes 2008;32(Suppl 1): Appendix 3. .