New SOB update Dec 1, 2015

The Ministry of Health has released a new update to the Schedule of Benefits (SOB) as of Dec 1, 2015.  You can download the text file to update your billing software from here : Updated SOB 2015.

Hospital (service location) Number and Classification

When billing it is required that you specify the location at which the service was provided. You may notice that the each location has a 4-digit number associated with it as well as a 2-letter classification. It may be confusing if you see multiple listings for the same location, each with a different number/classification. The correct location can be chosen based on the classification. An example of some locations with number and classification are shown in the figure below.

The meaning of the different 2-letter classifications are given below and can also be found here on pg. 5.

TYPE CODE BROAD SERVICE CLASSIFICATION
AC Therapeutic Abortion Clinics
AL Alternate Payments Program
AM Ambulatory Care
AS Ambulance Services
AT Acute Care Treatment Hospital
CA Children's Aid Society
CC Correctional Centre
CM Children's Mental Health Centre
CO Community Health Centres
CR Chronic Care Treatment Hosp. and Units of Hosp. (Complex Continuing Care)
DM Domiciliary Care Treatment Unit of Hospital
DT Detoxification Centre
FP Family Planning Unit
GR Gen. Rehab. Hosp. and Units of Hosp.
HC Home Care Program (Community Care Access Centres)
HF Home for the Aged
HL Public Health Laboratory
HO Health Organization
HU Public Health Unit
IF Independent Facilities
IN Min. Of Health Internally Used Classification
LI Law Enforcement
LT Interim Long Term Care
MH Mental Health Unit
NH Nursing Home (Long Term Care Beds)
NS Nursing Station PR Approved Private Radiological Facilities
PS Provider Services
PT Physiotherapist (inc. Physiotherapy Centres)
RT Rehab. Treatment Centre (Children's Treatment Centre) SF Schedule I and II Facilities
SH Supportive Housing
SO Health Service Organization
SR Special Rehab. Hosp. & Units of Hospitals
SS Special Schools
TC Treatment Centre - Addiction (only for the Northern Health Travel Grant Program)
TH Telehealth
TM Temporary Long Term Care

Special Visit Premiums for ER and Inpatient Ward

We have previously blogged about special visit premiums, but there is always more to cover and it is good to have a reminder of how your special visit premium works. JCL Medical Systems, an OHIP billing company in the GTA has written the following blog on Special Visit Premiums for ER and Inpatient Ward. Make sure you pay close attention because JCL has great experience in OHIP billing and anything they share will be helpful to you!

Special Visit Premiums for ER and Inpatient Ward By JCL Medical Systems  

How often have you been called to see a patient in hospital after a long shift, and thought: “If only there were some sign of appreciation…”

Well there is. Special visit premiums (SVPs) are designed for those times when physicians are called unexpectedly to care for patients and – beyond a few limitations – add a generous boost to a doctor’s income. Although most doctors are aware of SVPs for evening and night shifts, many still don’t know that unique weekend/holiday SVPs are available, and with another long weekend approaching quickly, we thought we’d discuss them.

How to apply SVPs to hospital billing

Keeping it Simple: Whether or not to bill SVPs It’s why you’re seeing the patient that matters: if you’ve been called urgently or unexpectedly, it’s a Special Visit.  If it’s a scheduled or routine visit - even if it takes place in the evening or on a weekend – it’s not.

Special Visit Premiums can be confusing because of all the rules, restrictions, and limitations. First off, let’s define a special visit: a “visit initiated by a patient or an individual on behalf of the patient for the purpose of rendering a non-elective service”. This is from GP43 of the Schedule of Benefits.  Any unexpected visit to a patient on a holiday or weekend is eligible for a SVP, except if the visit is part of hospital rounds or if the visit would be considered routine. Further, if the physician is following up on his or her own patient at his or her discretion, no special visit has taken place and no SVP would be payable.

  

The MOH has two different categories of SVPs for weekends and holidays – one for the first patient a physician sees at the destination, and one for any additional patients the physician sees on that same trip. The MOH also has a travel premium that’s payable on the first patient seen when the physician travels to the hospital from outside of hospital grounds.  To complicate things further, the SVPs are different depending on where the patient is seen, for instance in the Emergency Department or on the Ward. See the chart below:

Weekend and Holiday SVPs	Emergency Department Patients	Hospital In-Patients
Travel Premium	K963- $36.40	C963 – $36.40
First Patient Seen	K998 – $75.00	C986 – $75.00
Additional Patient Seen	K999 – $75.00	C987 – $75.00

For weekends and holidays, SVPs have very generous maximums. Physicians are limited to a maximum of 20 SVPs per day and up to 6 travel premiums in the Emergency Department and the same maximums for SVPs and travel premiums on the ward. Remember too that if you see a patient between midnight and 7am on a weekend or holiday, the night time special visits and travel premiums should be billed as they are worth more.

Example: Billing Special Visit Premiums on Labour Day

Dr. G, one of our Internal Medicine Specialists, is on-call at her hospital on Labour Day.  At 8am, she gets called in to consult on a patient in the ED and travels from home. While there, Dr. G is asked to consult on two other ED patients and is then asked by staff to see two in-patients on the ward. After seeing these patients, Dr. G decides to round on two of her own patients that she’d been following all week as MRP. Here’s what she would bill:

Patient 1	8am -called in from home to ED	A135/K998/K963
Patient 2	8:45am – still in ED	A135/K999
Patient 3	9:25am – still in ED	A135/K999
Patient 4	10:00am – requested by nurse to see admitted patient	A133/C986 (no travel!)
Patient 5	10:24am – requested by doctor to see admitted patient	A135/C987
Patient 6	10:55am – rounds on her own patient	C132/E083 (no SVP!)
Patient 7	11:10am – rounds on her own patient	C132/E083 (no SVP!)

Note for Psychiatrists: When billing SVP’s, use A895 instead of A195.  It’s not only the rule, it’s worth more!

Dr. G now catches a break and heads home. At 2:20pm, she’s called back to the ED for a couple of new consultations, and the process starts again with a new first patient seen premium (K998) and a new travel premium (K963). What if Dr. G forgot to add a SVP for a patient? No problem – we always keep a sharp eye out for that sort of thing and would have corrected her billing already.

Final steps after residency

The CMA has some great resources to help residents transition from residency to practice, one of which describes the final steps in finishing residency and beginning practice. This blog aims to summarize the chapter.

Hospital Privileges
The accreditation committee of hospitals meet on a periodic basis- to avoid delays in obtaining hospital privileges, plan to have your application submitted before the meeting. The application requires several documentation such as medical license, malpractice insurance certificates and sometimes certificate of adult criminal conviction. Cost of the application can be $100-150.

Certification Exam
Residents are required to sit their respective certification examination in the final year of their training. Application to write the exam must be done one year in advance. After passing the exam, residents are then certified to practice in their respective specialty and are invited to become a fellow of the Royal College of Physicians and Surgeons/College of Family Physicians meber.

Maintenance of Certification (MOC)
To demonstrate commitment to continuing professional development and to provide evidence to competency physicians are required to complete a minimum of 40 credits by participating in continuing professional development activities and reporting their outcome. As a resident up to 75 credits obtaining for activities undertaken as a resident can be transferred. For family medicine physicians are required to participate in Maintenance of Proficiency where they must complete 250 Continued medical education (CME) credits over a 5 year cycle.

Province Licensure
Application to either Royal College of Physicians and Surgeons/College of Family Physicians of Canada in the respective province must be made before practicing. Application are reviewed as they are received and peak times are from March-July. Provincial medical association membership is also generally required to practice in the respective jurisdiction.

Malpractice Insurance
Upon graduation residents are required to arrange their own malpractice coverage such that the insurance is in force the date medical practice begins. These dues are often paid by the employer. In some cases MOH may pay for part of the dues or funding arrangements can be made to minimize disruption of cash flow.

Billing
A billing number is required in order to earn money for the services provided on a fee-for-service basis. Upon successful registration with the respective provincial College of Physicians and Surgeons, physicians are eligible for a billing number. Applying for a billing number from the MOH should be done in a timely manner to delay payment.


The full chapter can be found here: Final Steps.

The use of subsequent visit codes post-operatively

The Education and Prevention Committee (EPC) releases bulletins providing answers to OHIP billing questions posed by physicians. In Volume 5, No. 3 they discuss the use of subsequent visit codes post-operation. This blog briefly summarizes the main points from the bulletin.

1.  Surgeons are not eligible for billing C122 and C123 for post-operative subsequent visits, however C124 subsequent visit is eligible for payment on the day of discharge. General surgeon's may also be eligible for C032 for the first post-operative visit.

2. In cases where surgeons are rotating on call where the surgeon on call is to visit all other physician's patients, the on call physician is not eligible to bill C124. Only the operating surgeon (MRP) is eligible for payment of C124. As long as the operating surgeon fulfills all requirements for billing C124 within 48 hours of discharge he/she can bill C124 even if the visit on the day of discharge is from the on-call physician.

3. In cases where an acute care nurse practitioner dictates the discharge summary and signs on behalf of the MRP, the MRP is not eligible for payment of C124.

4. If a patient dies during the night C124 is not payable as a subsequent visit was not performed. A771 may be billed for certification of death.

Reference: https://www.oma.org/Resources/Documents/0503EPC_Bulletin.pdf

OHIP Billing: Palliative Care

The SOB defines palliative care as "care provided to a terminally ill patient in the final year of life where the decision has been made that there will be no aggressive treatment of the underlying disease and care is to be directed to maintaining the comfort of the patient until death occurs".

This blog will review billing codes commonly used for palliative care billing followed by an example.

1. Special palliative care consultation A945 ($144.75)

This is an assessment following a written request from a referring physician. A minimum of 50 minutes should be spent with the patient or their family.

2. Palliative care support K023 ($62.75 per 1/2 hour unit)

This is a time-based service for providing pain/symptom management, emotional support and counselling. This can be billed with A945 after exceeding the first 50 minutes of the consultation.

3. Counselling K015 ($62.75 per 1/2 hour unit)

This can be billed when counselling relatives on behalf of a terminally ill patient.

4. Telephone management of palliative care G511 ($17.75 per call)

This can only be billed when the phone call is requested by the patient or their caregiver, and the phone call should be documented and summarized. This cannot be billed on the same day as a consultation or assessment and can only be billed by the MRP (or substitute MRP). Max 2 times/week.

5. Palliative care case management fee G512 ($62.75)

This can be billed when providing supervision of a palliative care patient for a period of 1 week. This  includes monitoring their condition, discussion with the patient and their family, arrangements for assessments, procedures or therapy, etc. This can only be billed by the MRP and G511, K071 (acute home care supervision) and K072 (chronic home care supervision) cannot be billing during the same week as G512. In the event of a death during the week, G512 can still be billed.

6. Palliative care also has special visit and travel premiums as outlined in the SOB table below:

Palliative Care Billing Example

As the physician you just completed a house call on a palliative patient which lasted 1 hour, during the daytime on a weekday and are going to manage their palliative care for a week. You should bill the following:

A901 ($45.15) + K023 (2 units- $125.50) + B966 ($36.40) + B998 ($82.50)  + G512 ($62.75) = $352.30

where A901 is for a house call assessment that at minimum meets the requirements of an intermediate assessment.

References: http://www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/sob_master11062015.pdf 

MC EDT- What is it and how do I register?

What is MC EDT?

Medical Claim Electronic Data Transfer, also known as MC EDT is an electronic service provided by The Ministry of Health and Long-Term Care (MOHLTC) which provides doctors with a secure method of transferring electronic claim files to and from the MOH. To access MC EDT all that is required is an internet connection as it is web based, allowing doctors to submit and retrieve their claim files seven days a week, 24 hours a day. Note however that there is weekly maintenance on Sunday mornings between 1:00-5:00 am and Wednesday mornings between 5:00-8:00 am at which time MC EDT is unavailable.

How to use MC EDT?

MC EDT can be accessed through a web page which provides a simple interface where doctors can upload and download claim files depending on whether they are submitting or retrieving their claim file. Note that, doctors still need a billing software to create their claim files for them as they must meet a specific format to be properly processed by the MOH. You have to pay for most billing software, however we are almost finished version 3 of Mo-Billing which will allow you to create your claim files for free!

How to register for MC EDT?

Before starting this process you should have a letter from the ministry providing you details for setting up you Go Secure account, such as your unique identifier.

1. To begin using MC EDT you must first register for a Go Secure account. To do so go to www.edt.health.gov.on.ca and select 'Register Now'.

2. After registration you should get an email from Go Secure, selecting the link in the email. You should now be at the login screen where you can enter your Go Secure ID (your email address) and the password you chose during registration.

3. After signing in you will be presented with the Email Validation screen, select 'here'. Follow the steps, where you will have to enter in information provided in your letter from the ministry.

4. Once you have completed step 3., go to www.edt.health.gov.on.ca and login using you Go Secure ID and password. At the Administration and MOHLTC Services screen you MC EDT enrolement should be complete and you can being using MC EDT to upload or download your claim files.

References: http://www.health.gov.on.ca/en/pro/publications/ohip/mcedt_mn.aspx

House Calls: General information and billing

General information about house calls

A house call is a physician visit made to the patient in their own home. This may include anyone who can't or shouldn't come to the office to see the doctor for reasons such as disability, dementia (may forget their appointments) or VRE positive. House calls may last anywhere from 15 to 60 minutes depending on the complexity of the case. Patients should be treated as if they were in the office; for this it is important to be open and adaptable to the environment and ensure you pack the appropriate equipment. Some suggestions of what you need to take with you include:

• Hand sanitizer
• Flashlight
• Stethoscope
• Anaeroid BP monitor and selection of cuffs (pediatric, standard and large)
• Portable Otoscope and ophthalmoscope
• Tongue depressors
• Ear speculums and lighted ear curettes
• Tuning forks
• Bandage scissors
• Tape measure
• Gloves and lubricant
• Alcohol swabs, bandaids
• Urine bottles, C&S swabs and specimen bags
• Lab requisitions, X-ray requisitions, Prescription pad
• Dementia and depression screening tools (e.g. Montreal Cognitive Assessment, Geriatric
Depression Scale)
• Community DNR forms
• Medication flow sheets
• Patient chart (paper or laptop for EMR)
• Waterproof pads (for any procedure or exam that could dirty the patient’s furniture or bed, and to
put bag on)

Before conducting house calls it is important to consider your safety. You should be comfortable going to the patients home and should not feel concern to be surrounded  by any of the other occupants of the home. Ensure to list your house calls on your day sheets or leave the addresses with someone at all times. Other cautionary notes include steering clear of any pets you may be uncomfortable with by simply asking the patient to put the pet in a separate room and avoid tag along bed bugs!

Reference: Caroline A Knight MD CCFP FCFP

House Call Billing Codes (OHIP Schedule of Benefits)

House call assessment: A house call assessment is a primary care service rendered in a patient’s home that satisfies, at a minimum, all of the requirements of an intermediate assessment.

A901 House call assessment............................................................................................ $45.15

Payment rules: A house call assessment is only eligible for payment for the first person seen during a single visit to the same location. Services rendered to additional patients seen during the same visit are payable at a lesser fee; i.e. bill as an in office assessment.

Complex house call assessment: A complex house call assessment is a primary care service rendered in a patient's home to a patient that is considered either a frail elderly patient or a housebound patient (defined below). The service provided must satisfy, at a minimum, all of the requirements of an intermediate assessment.

A900 Complex house call assessment ............................................................................. $45.15

Payment rules: A complex house call assessment is only eligible for payment for the first person seen during a single visit to the same location.

1. A frail elderly patient is defined as:

a. 65 years or older with one or more of the following age-related illness(es), condition(s) or presentation(s):
     i. Complex medical management needs;
     ii. Polypharmacy;
     iii. Cognitive impairment (e.g. dementia or delirium);
     iv. Age-related reduced mobility or falls; and/or
     v. Unexplained functional decline not otherwise specified.

AND

b. resides in a home that includes:
     i. The patient's home; or
     ii. Assisted living or retirement residence (but does not include a long-term care home).

2. A housebound patient is defined as:

a. A person will be considered homebound where all the following criteria are met:
     i. The person has difficulty in accessing office-based primary health care services because of medical, physical, cognitive, or psychosocial needs/conditions;
     ii. Transportation and other strategies to remedy the access difficulties have been considered but are not available or not appropriate in the person's circumstances; and
     iii. The person's care and support requirements can be effectively and appropriately delivered at home.

Medical record requirements: Complex house call assessment is not payable If the medical record does not:
1. Demonstrate that an intermediate assessment was rendered; and
2. Demonstrate that the patient was a frail elderly or housebound patient.

House call assessment - Pronouncement of death in the home: A house call assessment - Pronouncement of death in the home is the service rendered when a physician pronounces a patient dead in a home. This service includes completion of the death certificate and counselling of any relatives which may be rendered during the same visit.

A902 House call assessment - Pronouncement of death in the home.............................. 45.15

Claims submission instructions: Submit the claim using the diagnostic code for the underlying cause of death as recorded on the death certificate.

Special visits and travel premiums for house calls

Note:
1. The maximum number of services per physician per day for B960 is 2, for any combination of non-elective and elective visits.
2. The maximum number of services per physician per day for B990 is 10, for any combination of non-elective and elective visits.
3. Special visit to patient’s home premiums are only eligible for payment for first patient seen, regardless of number of patients seen during one visit to a home or to one or more living units in a multiple resident dwelling. A multiple resident dwelling is a single location that shares a common external building entrance or lobby e.g. apartment block, rest or retirement home, commercial hotel, motel or boarding house, university or boarding school residence, hostel, correctional facility or group home.

House call bonus

**PLUS 20% premium on value of claims for house call visits in excess of level C if at least 75% house calls are A900 (Complex house call).

Note:
1. No bonus or premium for FFS
2. FFS, CCM, FHG, FHN - house calls are OUT of basket (pay 100%)
3. FHO - A900, A901, and special visit premiums are IN basket (pays 15%), Travel premiums are OUT of basket (pay 100%). A902 (and all palliative care) is OUT of basket

Reference: OHIP Schedule of Benefits and Caroline A Knight MD CCFP FCFP

Post ICU billing

Content provided by Judy MacAlister

When a patient is admitted to the ward after ICU, there are specific codes that should be used by the hospitalist that is assuming the patient's care for Day 1 and Day 2 post ICU: 

Day 1 post ICU: C142 + E083 
Day 2 post ICU: C143 + E083 

Note that if you see the patient in the unit, you cannot bill  these post ICU care codes.

To clarify let me share an example: The patient is admitted from the ICU to the ward today.  Primary care is with the physician providing care in the unit for that day. You spend a little time with the patient in the unit before they are admitted to the ward and bill concurrent care.  If you provided this care in the unit and billed C101 (patient seen on a visit to ICU, Pg. GP65 in SOB 2014) instead of concurrent care, then you are unable to bill C142 and C143.  Bill concurrent care for the day of transfer only (do not bill the ICU code C101), then you are able to bill the C142 and C143 as applicable.

Billing for Hospital In-Patient Case Conference

Content by guest blogger Judy MacAlister

While much time is spent on shift change discussing the patients and their needs, physicians need to be aware of when it is appropriate to bill for K121A Hospital In-Patient Case Conference (Page A24 in the 2014 SOB).  Many physicians are billing and getting paid for K121A Case Conference while not meeting the requirements set out by the Ministry.  If their billing is ever reviewed by the Ministry, they will be charged with billing for services not rendered.

The requirements of a case conference is; it must be a scheduled appointment; there must be at least 2 other participants in addition to the most responsible physician, this can include other physicians or regulated health professionals regarding a hospital in-patient.  The outcome of the conference must be documented.  

Watch How Mo-Billing Works

We recently finished our 'how-to' videos for Mo-Billing. Check them out!

Family Medicine

You can also watch how Mo-Billing works for:

Internal Medicine/Cardiology

Anesthesiology

OHIP billing for Immunizations

Content provided by guest blogger
 Linda Rehmund

A common claim submission error seen usually by general practitioners in an office setting would apply to immunizations. Physicians often leave out G700 ($5.10), the basic fee-per-visit premium, billed when the procedure performed is the sole reason for the visit. This add-on code is eligible for payment in addition to any of the following immunization codes G538, G590, G840, G841, G842, G843, G844, G845, G846, G847 or G848.  These can be found on page J43 under the section Immunizations in the 2014 SOB. All codes in this section marked with a '+' can be billed with G700. 

To avoid rejection the G700 and the immunization codes given above should be submitted on the same day, in the same claim, and only once per patient per day.  Again, remember that G700 applies only when the sole purpose of the claim is for providing immunization.  If there has been a consultation code entered then G700 would no longer apply, and you would only use the immunization code along with your consultation code. 

Additional information about G700 can be found on page J3 in the Preamble.

OHIP Billing for Counselling Services

Content by Guest Blogger
 Judy MacAlister

Physicians doing inpatient hospital work often spend a sizable amount of time counselling relatives on inpatients. Physicians run in to a problem when they try to bill for the counselling services they provided because when you bill for any service, generally a counselling component will not be  paid if it is billed in conjunction with any other service.  However, there are some exceptions where counselling codes for time spent with relatives can be billed and paid out with other services . The exception specifically for counselling relatives in an inpatient setting is K002A (See Counselling on Pg. GP39 in SOB 2014). Although K015A is listed as an exception in the SOB as well, in my experience, whenever I have billed K015A with a procedure code, the MOH pays the lesser amount and the rejection I receive is "not permitted with services provided". So, stick with K002A!

K002A is billed for an interview with relatives or a person who is authorized to make treatment decisions.  The fee is $62.75 per 1/2 hour unit.  As the physician you are required to book the appointment, it must last at least 20 minutes and the purpose of the interview should not be solely for obtaining consent and the information obtained cannot be information that is normally obtained in the consultation or assessment of the patient. (Pg. A19 in SOB)

For example, if you are on call and you admit a patient to the ICU if you advise their relatives that you will speak with them in approximately 2 hours then you have now completed the Ministry's requirements by scheduling an appointment.  Then if the appointment lasts at least 20 minutes you can bill K002A.  You can bill this fee more than once per hospital admission if required.

Admission billing codes in ER

One month ago, I wrote an entry about basic ER billing.

As a follow up, here is some clarification about admission codes.

There are three codes a ER doctor can use for the admission: H105, C004 and C933.

H105 is for "interim admission orders". In one ER I used to work in in the past, the ER docs would write the admission order, but would not dictate/write the admission note. Once the patient was brought up to the floor, the family doctor would dictate the admission note and would become "the most responsible physician." In this case, H105 ($18.10) would be an appropriate code to use. Think of it as the admission reassessment.

C004 is for an admission somewhat more involved. The ER doctor would write the admission orders, do the dictation for the admission note, but the patient would still be admitted under another doctor; the ER doctor is not going to follow during the admission.  Use C004 ($30.70) for such an admission.

C933 ($79.20) is for the case where you would admit the patient under yourself, and you will become the most responsible physician during the admission.

OHIP billing how-to for Internal Medicine

This blog is intended to teach the basics of OHIP billing for internal medicine specialists working in a hospital setting. Generally, as an internal medicine specialist, a patient will be referred to you for a consult. To bill for this first initial consult, you need to determine the following for your initial consult:
 
Location (where did your initial consult take place?): ER; Ward
Type (the type of consult): General; Comprehensive; Limited; Repeat (there are others)
Time (time of day you did the consult): Weekday 7:00-17:00; Weekday 7:00-17:00 during Office Hours; Evening Weekday 17:00-24:00; Weekend/Holidays 7:00-24:00; Nights 00:00-7:00
Travel (did you have to travel to go see the patient): Yes; No

Depending on your answers from above we can determine which fee codes to bill to the Ministry of Health for the initial consult. Using your answers follow the breakdown below to find out which codes you need to bill. The first half is for ER visits while the second half covers Ward visits.  

If ER is chosen as location and…

·Type is:            

o   General = A135A

o   Comprehensive= A130A

o   Limited= A435A

o   Repeat= A136A

· Time is: 

o if Travel=YES (if you had to travel then no matter the time of day you can bill for your travel and first person seen premiums shown below, known as your special visit premiums)

§  Weekday 7:00-17:00 = K960A, K990A

§   Weekday 7:00-17:00 during Office Hours = K961A, K992A

§  Evening Weekday 17:00-24:00 = K962A, K994A

§  Weekend/Holidays 7:00-24:00 = K963A, K998A

§   Nights 00:00-7:00 = K964A, K996A

o   if Travel=NO (if you did  not travel then you can only bill for your first person seen premium shown below; however if you saw the patient during the week from 7:00-17:00 you can't bill for the first person seen premium)

§  Weekday 7:00-17:00: nothing

§   Weekday 7:00-17:00 during Office Hours: K992A

§  Evening Weekday 17:00-24:00: K994A

§  Weekend/Holidays 7:00-24:00: K998A

§   Nights 00:00-7:00: K996A

· If you admitted the patient add: E082A

 
If Ward is chosen and…
 

·Type is: (Use these codes, but if both Travel=NO and Time=Weekday 7:00-17:00, use the codes listed after this)            

o   General = A135A

o   Comprehensive= A130A

o   Limited= A435A

o   Repeat= A136A
 

·Type if Travel=NO and Time=Weekday 7:00-17:00: (Essentially all your codes listed above now start with 'C' instead of 'A')

o   General = C135A

o   Comprehensive= C130A

o   Limited= C435A

o   Repeat= C136A

·Time is:

o   if Travel=YES (if you had to travel then no matter the time of day you can bill for your travel and first person seen premiums shown below, known as your special visit premiums)

§  Weekday 7:00-17:00: C960A, C990A

§   Weekday 7:00-17:00 during Office Hours: C961A, C992A

§  Evening Weekday 17:00-24:00: C962A, C994A

§  Weekend/Holidays 7:00-24:00: C963A, C986A

§   Nights 00:00-7:00: C964A, C996A

o   if Travel=NO (if you did  not travel then you can only bill for your first person seen premium shown below; however if you saw the patient during the week from 7:00-17:00 you can't bill for the first person seen premium)

§  Weekday 7:00-17:00: nothing

§   Weekday 7:00-17:00 during Office Hours: C992A

§  Evening Weekday 17:00-24:00: C994A

§  Weekend/Holidays 7:00-24:00: C986A

§   Nights 00:00-7:00: C996A

That covers your fee codes for the initial visit with the patient. Now what happens if you continue to visit the patient daily until they are discharged?

You can use the following fee codes scheme:

Initial visit: determined using the logic above

Day after admission: C122A + E083A (The E083A is the premium if you are the most responsible physician for the patient)

Day 2 after admission: C123A +E083A

From Day 3 after admission to discharge: (Note that you use a different code for these subsequent visits, depending on when you are seeing the patient relative to their admission date. There are restrictions on how many times you can use C137A and C139A).

-          C132A (if 5 weeks from admission) +E083A

-          C137A (if 6-13 weeks from admission) + E083A

-          C139A (if past 13 weeks from admission) + E083A

Discharge: C124A + E083A

Our Mo-Billing app actually auto-generates all these codes for you given you provide the admission date, the first day you saw the patient, the last day you saw the patient and whether this was the day of discharge and the location, type, time and travel of the initial consult. To help with the understanding here are 3 examples right from our Mo-Billing app:

Example 1

 

Admission Date: Feb 15 2014

First Seen Date: Feb 15 2014 (Day of initial consult, the first day you saw the patient)

Last Seen Date: Feb 20 2014 (Last date you saw the patient, it is also the discharge date)

Enable autogeneration of codes: activated

Location: ER

Type: General

Time: Weekday 07:00-17:00

Travel: Yes

 

 

Feb 15 2014 : A135A (ER and General), K960A, K990A (ER, Weekday 07:00-17:00, Travel=YES), E082A

Feb 16 2014: C122A , E083A (day1 after admission)

Feb 17 2014: C123A, E083A (day2 after admission)

Feb 18 2014: C132A, E083A (I know to use the code for within 5 weeks from admission code since Feb 18 2014 is only 3 days after the date of admission so it falls within this category. If the date was  April 5 2014 then I would use the code C137A, E083A since this date falls within 6-13 weeks after the admission date)

Feb 19 2014: C132A, E083A

Feb 20 2014: C124A, E083A (since the last seen date is the same as discharge otherwise I would use C132A again)

 

Claim Example 2

 

Admission Date: Feb 15 2014

First Seen Date: April 15 2014 (first day you saw the patient, not the same as admission date)

Last Seen Date: April 20 2014 (last day you saw the patient, not the discharge date)

Enable autogeneration of codes: activated

Location: Ward

Type: Comprehensive

Time: Nights 00:00-07:00

Travel: No

 

 

April 15 2014 : A130A (Ward, Comprehensive, Travel=NO), C996A (Ward, Nights 00:00-07:00, Travel=NO)

April 16 2014: C137A , E083A (I know to use the code for within 6-13 weeks from admission since April 16 2014 is 8 weeks and 3 days after the date of admission so it falls within this category. If the date was  Sept 5 2014 then I would use the code C139A, E083A since this date falls after 13 weeks from the admission date)

April 17 2014: C137A, E083A 

April 18 2014: C137A, E083A

April 19 2014: C137A, E083A

April 20 2014: C137A, E083A (since the last seen date is not the same as discharge)

 

Claim Example 3

 

Admission Date: Feb 15 2014

First Seen Date: Feb 15 2014 (first day you saw the patient, the same as admission date)

Last Seen Date: Feb 15 2014 (last day you saw the patient, the same as discharge date)

Enable autogeneration of codes: activated

Location: Ward

Type: Repeat

Time: Weekday 7:00-17:00

Travel: No

 

 

Feb 15 2014 : C136A (Ward, Repeat, Travel=No)

Note: All this information was obtained from documents made publicly available by the MOHLTC. We are not to be held liable for any occurrences that arise from following our understanding of  medical billing.