Breaking down the common family practice billing codes

The Section on General & Family Practice of Ontario (SGFP) release an up to date document of Common Family Practice Codes (2011 version) each year. Sometimes the descriptions on this document aren’t enough for physicians and medical staff to decipher which billing code to use. The purpose of this blog entry is to break down the Common Family Practice Billing Codes so it can be better understood. Download the document as I will be referring to it in this blog, so hang in there and follow along closely.

The first four codes on the document are A001, A007, A003 and A004; these are your office visit codes. Typically for most office visits you would use A007. Note that A003, a full assessment, can only be billed twice per year per patient, each time with a different diagnostic code.

The next following four codes, K130, K131, K132 and K017 are your periodic health visit codes encompassing educational discussions.

A008 is the billing code which is supposed to be billed with WSIB claims. For example, if you are examining the patient for an injury which occurred on the job but they also happen to have another unrelated health concern which you examine at the same time, you can bill A008.

A888 can be billed (instead of the typical A007) when you see a patient during weekends/holidays whether it is scheduled or unscheduled. Note that this code can be used for weekday visits from Christmas to New Years, which you should take advantage of as the pay is higher! Immediately after A888, you have E080 which is a premium you can bill if you are seeing a patient that has been discharged from the hospital within the past two weeks.

After there is a block of K billing codes, K005, K002, K007, K013, K033, K623; these are your counseling codes. There isn’t a great distinction between K005 and K007, where you provide less formal listening and support. K002 is what you bill if you are talking with an authorized individual regarding directives for the patient. K013 is what you bill if you are building a therapeutic relationship with the patient by providing educational dialogue. K013 can only be billed 3 times in a year (max) per patient, after three times of using this code start billing K033.

Following there is another group of K codes, K050-K056, which are your form codes. These are the billing codes you use to fill out various different forms for patients.

A901 and A902 are your house call billing codes. K070-K072 are your homecare billing codes.

I won't be covering hospitalist billing as this was covered in our previous blog entry. 

For long term care all you would bill is W010, which covers two visits per patient per month. W010 covers a wide range of services, see the ** note corresponding to this code on the bottom of the page- that's why you generally bill W010 only. 

For obstetrics you will use your P billing codes. Generally you would bill P005 + P003 or P004 for giving the integrated prenatal screening discussion/education. You can only bill this once during the pregnancy. Typically after the initial prenatal screening process you would bill P004 for the entire pregnancy.

Office procedures are pretty straight forward but make sure you don’t miss out on billing E542, the tray fee, this can also include using the autoclave on your instruments.

This information can be found in the Schedule of Benefits released by the MOHLTC.

For those interested, Mo-Billing App actually provides an electronic platform where you can collect, store, deliver (to your billing agent) and retrieve all your billing information. You can simply create claims on the go and have most of your fee codes auto-generated for you depending on your type of practice.

On the app, all hospitals and diagnoses are searchable so you don't have to worry about memorizing any codes. Furthermore, to save time you can take a picture of the patient sticker rather than typing out the patient information.  Read more about the app at www.mo-billing.ca. Or you can create an account for free at http://app.mo-billing.ca.