General Practitioner

Transcription

1 Palliative Care/End of Life Related Fees Service Type Fee code When to use General Practitioner Palliative Care Planning Once a patient living in the community (own or family home or assisted living; LTC excluded) is deemed to be palliative (fulfills eligibility for Palliative Benefits Program), the GP may undertake a Palliative Care Planning visit (30 min face-to-face; Effective July 1, 2015 requires start/end times in chart and fee submitted) to review prognosis, course of condition, patient/family wishes, etc. Care following is then billed using appropriate visit codes. Telephone Follow-up Following the planning visit and successful billing of 14063, the GP may access up to 5 telephone/ follow up management fees per calendar year with the patient or patient s representative. Office visit < 2 years years years years years years Office counselling (Minimum 20 minutes requires start/end time in chart and fee submitted) Billed by an Attachment Initiative participating FP when providing telephone follow-up for any patient for whom they are the MRP community GP. Each GP has access to 1500 telephone management fees per calendar year. These are available in addition to once all have been utilized in any calendar year < 2 years years years years years years Office CPX < 2 years years years years years years House Call hrs 7 days per week for both urgent (called to) and planned proactive care Additional pts seen at < 2 years house call use age years differential out of office years visit fee years years years

2 Service Type Fee code When to use Hospital acute care visit Daily MRP acute or sub-acute care (Billable until patient Supportive care daily up to 10 then 1 per week deemed to be palliative First patient of the day incentive (13338) billed in addition to then can switch to 13008, or (only 1 per day regardless 00127) how many facilities attended) Terminal care facility Facility care for patients deemed to be palliative visit (depending on (last six months of life) billable up to daily for up patient Dx/condition to 180 days. For services beyond 180 days, bill with only regardless if in e-note outlining reasons for need palliative bed or not First patient of the day bonus billed in addition to (acute/ltc/hospice) 13008, or (only 1 per day regardless how many facilities attended) Long Term care visit hrs 7 days per week for urgent (called (Billable until patient to see) care deemed to be palliative Routine care billable up to once very two weeks, if then can switch to more frequent needed, bill with e-note 00127) First LTC patient of the day bonus billed for first patient (non-urgent) seen of the day in addition to for visit (Nov 1, 2010, no longer available) * Specially called to Called in evening ( ) but not seen until see at home, LTC, out of hr acute care or hospice visit outside Called and seen between 2300 & 0800 hr. out of visit Specially called to see Called urgently and seen weekdays ( hr) in acute care or hospice Called and seen weekday evenings ( hr) care other times than out of *above visit Called and seen Sat/Sun/Stat ( hr) out of visit Advice about a patient in Community Care by phone or fax Attachment Conferencing Billed when called by Allied Care Provider (eg. Home care nurse) for brief advice about a patient in care (in LTC or community care at home) Billed by an Attachment Initiative participating FP when participating in a conference with at least 1 other Allied Health Professional, regarding a patient for whom the FP is the community/longitudinal most responsible FP. may be in any location: Acute care; other facility; community. Max 2 units per calendar day per patient and 18 units per calendar year patient. Replaces 14015, & for attachment participating FPs.

3 Service Type Community Conferencing (For Non- Attachment participating FPs) Facility Conferencing (For Non- Attachment participating FPs) Discharge Planning Conferencing (GP) (For Non- Attachment participating FPs) Urgent (<2hr) Telephone advice from Spec/GP with specialty training GP Advice to a Nurse Practitioner Physician to Physician Rapid Telephone Advice Fee Fee code When to use Billed by FP who is not participating in Attachment Initiative, when patient located in community (home or assisted living) when conferencing with at least 1 other health professional (includes specialists) about a palliative/end-of-life patient to develop and implement a plan to keep the patient safe in their location. Per 15 min or greater portion thereof. Max 2 units per calendar day per patient and 6 units per calendar year patient. Replaced by for attachment participating FPs Billed by FP who is not participating in Attachment Initiative, when attending a care conference with at least 2 other AHPs, at an approved facility, regarding a patient for whom the FP is the community/longitudinal most responsible FP. Max 2 units per calendar day per patient and 6 units per calendar year patient. Replaced by for attachment participating FPs Billed by FP who is not participating in Attachment Initiative, when attending an acute care discharge planning care conference with at least 2 other AHPs, regarding a patient for whom the FP is the community/longitudinal most responsible FP. Max 2 units per calendar day per patient and 6 units per calendar year patient. Replaced by for attachment participating FPs Billed by any FP who is the MRP for the care of the patient regardless of location of patient. This fee is billable when the patient s condition requires urgent conferencing with a specialist or GP with specialty training, and the development and implementation of a care plan within the next 2 hours to keep the patient stable in their current environment The intent of this fee is to support collaboration between nurse practitioners and community family physicians. This fee is billable when providing advice by telephone or in person when a Nurse Practitioner (NP) in independent practice (ie. Not employed as staff in a FP practice) has contacted a GP for advice regarding patients for whom the NP has accepted the responsibility of being the Most Responsible Provider for that patient s community care. (eg. Survivorship NP with BCCA) Specialist & GP with Specialty Training For Specialist advice provided within two hours of a call made to an initiating physician not payable for written communication, e.g., fax, letter, . Billed by specialist for two-way telephone communication (including other forms of electronic verbal communication) regarding assessment and management of a patient but without the consulting physician seeing the patient.

4 Service Type Fee code When to use Urgent (< 2 hrs) GP with spec training Telephone advice Specialist Telephone Management Advice Fee GP with specialty training Telephone Management Advice Specialist Scheduled Telephone Follow-Up Fee Billed by GP with specialty training for two-way telephone communication (including other forms of electronic verbal communication) regarding assessment and management of a patient but without the consulting physician seeing the patient. Conversation must take place within two hours of the initiating physician s request. Not payable for written communication Fee is for Specialists advice and guidance with the management of a patient, when providing telephone advice to the initiating provider (Specialist, General Practitioner or Allied Care Provider) within seven days of an initiating call. A chart entry that includes advice given and to whom is required. Billed for twoway telephone communication (including other forms of electronic verbal communication) regarding assessment and management of a patient but without the consulting physician seeing the patient. Initiation may be by phone or referral letter Fee is for GP with Specialty Training advice and guidance with the management of a patient, when providing telephone advice to the initiating provider (Specialist, General Practitioner or Allied Care Provider) within seven days of an initiating call. A chart entry that includes advice given and to whom is required. Billed for twoway telephone communication (including other forms of electronic verbal communication) regarding assessment and management of a patient but without the consulting physician seeing the patient. Initiation may be by phone or referral letter For Specialists to have a scheduled follow-up phone visit with their own patient when a face-to-face visit is not required. The telephone follow-up must be pre-scheduled with the patient in order to bill this fee. This fee applies to two-way direct telephone communication (including other forms of electronic verbal communication) between the Specialist and patient, or a patient s representative. Not payable for written communication (i.e. fax, letter, ). This fee is only payable for scheduled telephone appointments with the patient. Access to this fee is restricted to patients having received a prior consultation, office visit, hospital visit, diagnostic procedure or surgical procedure from the same physician, within the 18 months preceding this service.

5 Service Type Fee code When to use GP with Specialty Training Scheduled Telephone follow up Fee Hospital and office care This fee applies to two-way direct telephone communication (including other forms of electronic verbal communication) between the GP with specialty training and patient, or a patient s representative. Not payable for written communication (i.e. fax, letter, ). This fee is only payable for scheduled telephone appointments with the patient. Access to this fee is restricted to patients having received a consultation, visit, diagnostic procedure or surgical procedure from the same GP with specialty training, within the 6 months preceding this service. See section specific fee guide for appropriate fee codes for hospital and office services. Specialist Discharge Care Plan Fee G78717 This fee is intended to support clinical coordination leading to effective discharge and community based management of complicated patients. It is to be billed for patients who require community support upon discharge and are at risk of re-admission. Payable to the Specialist who is the MRP for the majority of the patient's in-hospital care and writes the care plan. Payable for the communication and clinical oversight of a patient care plan for complex patients. Primary care provider must be notified of admission by phone, fax, or electronic means within 24 hours for patients with an estimated length of stay greater than four days. must be an admitted in-patient with length of stay greater than four days. The written Discharge Care Plan must be completed and shared at the time of discharge with the patient and the patient's primary health care provider within 24 hours of discharge.

6 Service Type Fee code When to use Specialist Advance Care G78720 Paid only to the Specialist Physician for Advance Planning Discussion Care Planning discussions and plan development for patients presenting with: a chronic medical illness or complex comorbidities, and a deteriorating quality of life or end-stage disease state. The advance care planning discussion should include sharing information and resources on how a patient can create an advance care plan, including Advance Directives. A care plan form is required to be completed and added to the patient's chart and the discussion summarized in the consultation report including any decisions about the patient's future health care wishes. (The care plan form template is available at: The care plan template form must be completed and shared with: - the patient, and - the patient's primary health care provider.