Billing in the Time of COVID-19

For dates of service on or after Oct 1, 2021, two  temporary fee codes for adult respiratory immunizations (influenza, pneumococcal, and pertussis in pregnancy) are available.

• Fee code 10040 will allow physicians to bill for respiratory immunizations done in addition to an in-person visit for an unrelated reason (office visit, prenatal visit, counselling, consultation etc).
• Fee code 10041 will allow physicians to bill for respiratory immunizations in patients 19 years of age or older done without a visit for an unrelated reason.

You can read more here.

A new temporary fee code for provision of COVID-19 immunization advice is effective for dates of service on or after April 15, 2021. As of May 5, 2021, the claims system is now ready to accept the fee code, so you can submit your billings. 

• Fee code 10045 will allow physicians to bill for COVID-19 immunization advice provided in addition to an in-person visit for an unrelated reason (office visit, telehealth visit, prenatal visit, counselling, etc.). The physician time with the patient for the advice must exceed 10 minutes.

You can read more here.

Three new temporary fee codes for COVID-19 immunizations are effective for dates of service on or after Jan 25, 2021.

• Fee code 10042 will allow physicians to bill for COVID-19 immunizations done in addition to an in-person visit for an unrelated reason (office visit, prenatal visit, counselling, consultation etc).
• Fee code 10043 will allow physicians to bill for COVID-19 immunizations done without a visit for an unrelated reason, if the visit takes 10 minutes or less.
• Fee code 10044 (billed together with 10043) will allow physicians to bill for COVID-19 immunizations done without a visit for an unrelated reason, if the visit takes more than 10 minutes.

You can read more here.

The end date for these fee codes was April 30, 2021.

For dates of service on or after Oct 1, 2020, two new temporary fee codes for adult respiratory immunizations (influenza and pneumococcal) are available.

• Fee code 10040 (now active) will allow physicians to bill for respiratory immunizations done in addition to an in-person visit  for an unrelated reason (office visit, prenatal visit, counselling, consultation etc).
• Fee code 10041 (now active) will allow physicians to bill for respiratory immunizations in patients 19 years of age or older done without a visit for an unrelated reason.

You can read more here.

The daily volume limits for office visits, counselling, and complete examinations have been reinstated, effective October 1, 2020.

The fee codes to which these rules apply are:

• Office visits: 12100, 00100, 15300, 16100, 17100, 18100
• Office counselling: 12120, 00120, 15320, 16120, 17120, 18120
• Office complete examinations: 12101, 00101, 15301, 16101, 17101, 18101

Daily volume limits do not apply to other fee codes, including telehealth fee codes.

See MOC for more information.

Management of Maintenance Opioid Agonist Treatment (OAT) for Opioid Use Disorder

Changes have been made to fee code 00039, so that visits required to support substance use risk mitigation in the context of COVID-19 can be billed in addition.

• Prior to this change, counselling and visit fees related only to substance use disorder were not payable in addition.
• Effective July 23, 2020, visits required to support Substance Use Risk Mitigation in the context of COVID-19 can be billed with a claim note record indicating “COVID-19 risk mitigation”.

You can read more here.

Until further notice, chronic disease management visits provided by an Allied Care Provider (ACP) and submitted under 14029 may be provided in person or via Telehealth (video or phone).

• 14029 is a $0 fee code that can be billed for a visit provided by a college-certified Allied Care Provider working within the family physician’s practice team.
• This change is effective as of June 1, 2020.
• Physicians submitting 14029 for services provided more than 90 days prior should submit such claims with submission code “A”.

You can read more on the Team-Based Care section of the Simplified Fee Guide (member benefit).

Chronic Disease Management fees

Chronic Disease Management fees (14050, 14051, 14052 and 14053) may now be billed after one year of care if the two required visits were provided by telehealth.

• Both of the two required visits may be a physician visit. Office, prenatal, home, long term care, or physician telehealth visits qualify.
• Alternatively, one of the two required visits must be a physician visit while the second visit may be:
  1. a telephone visit (14076) or
  2. a group medical visit (13763-13781) or
  3. an in-person visit with a college certified allied health provider (14029) working within the family physician’s practice.

If you are paid under an alternate payment/ funding model, the same change is true for the comparable Chronic Disease Management fees (14250, 14251, 14252, 14253).

Personal health risk assessment (prevention) fee

The required face-to-face visit to provide a personal health risk assessment can now be provided via telehealth.

Physicians should include a note record when billing 14066 if the visit was provided to the patient via telehealth.

Age-adjusted telehealth fee codes for visits, counselling and consultations done by phone or video will come into effect on June 1, 2020. These new fees have the same value as the in-person fee codes for similar patient encounters.

Download a one page cheat sheet on the Telehealth Fee Codes effective June 1, 2020.

• These fee codes are for services delivered by phone or video.
• These fee codes should be used regardless of the physician’s location (home, office or Health Authority approved facility).
• Business Cost Premium (BCP) will apply to all of them.
• Retro payments will not be made for dates of service prior to June 1, 2020.
• From March 16 – May 31, 2020,  the same telehealth fee codes for visits, counselling and consultations done by phone or video are to be used for patients, regardless of age.  (13037 and 13038 in most circumstances). From June 1 onwards, use the new fee codes for phone and video services.

Read more here.

The Business Cost Premium (BCP) will be temporarily expanded to apply to in-office telehealth fee items during the COVID-19 pandemic. This is effective May 1, 2020 (not retroactive). Read more here.

Eligible BCP claims require submission of the unique facility number you received when you registered for the BCP as well as location code A, which identifies Practitioner’s office – in community. The appropriate facility number and service location code is based on where the service would have been provided if it had been performed face-to-face.

Check your EMR to make sure the facility number and location code come up when telehealth fees are billed.  If not, you or your MOA will have to manually add the codes for each billing or hold the billings until your EMR is updated.

Remember: In order to receive the BCP, physicians need to register their facility (clinic) and attach themselves as a practitioner of the facility.

You can read more about the BCP, including eligible fees, payment details and the registration process here.

Three new temporary fees have been created for family physicians.  Two of the new fees are similar to existing FPSC fees, but expand accessibility and increase capacity to provide virtual care. There is one new fee to better enable communication between providers during the COVID-19 pandemic.

• T13706 FP Delegated Patient Telehealth Management Fee – similar to FPSC’s FP Patient Telephone Management Fee (14076)
• T13707 FP Email/Text/Telephone Medical Advice Relay or ReRX Fee – similar to FPSC’s FP Email/Text/Telephone Medical Advice Relay (14078).
• T13708 FP COVID-19 communication with specialist and/or allied care provider is a new fee.

Key features of the T13706 and T13707 are:

• No annual limits on the number of fee codes billable per physician
• Prescription renewal is billable without a patient interaction under T13707
• These new temporary fee codes are available to any family physician, not just those who have submitted 14070 and 14071
• Increased opportunity to delegate some virtual care with use of new codes T13706 or T13707 which have no annual limits

T13706 FP Delegated Patient Telehealth Management Fee ………………$20.00

Notes:

1. For verbal, real-time telephone or video technology communication discussion between the patient or the patient’s medical representative and a College-certified allied care provider (e.g.: Nurse, Nurse Practitioner) employed within a physician’s practice. Not payable when the delegated representative is paid or funded by alternate means by a health authority or the Ministry of Health.
2. Chart entry must record the name of the person who communicated with the patient or patient’s medical representative, as well as capture the elements of care discussed.
3. Not payable for prescription renewals, anti-coagulation therapy by telephone (00043) or notification of appointments or referrals.
4. Only one service payable per patient per day.
5. Not payable on the same calendar day as a visit or service fee by same physician for same patient.
6. Not payable to physicians working under salary, service contract or sessional arrangements whose duties would otherwise include provision of this care

T13707 FP Email/Text/Telephone Medical Advice Relay or ReRX Fee…….$7.00

Notes:

1. Email/Text/Telephone Relay Medical Advice requires two-way relay/communication of medical advice from the physician to eligible patients, or the patient’s medical representative, via email/text or telephone.  The task of relaying the physician advice may be delegated to any Allied Care Provider or MOA working within the physician practice.
2. Chart entry must record the name of the person who communicated with the  patient or patient’s medical representative, as well as the advice provided, modality of communication and confirmation the advice has been received.
3. Payable for prescription renewals without patient interaction.
4. Not payable for anti-coagulation therapy by telephone (00043) or notification of appointments or referrals.
5. Only one service payable per patient per day.
6. Not payable on the same calendar day as a visit or service fee by same physician for same patient.
7. Not payable to physicians working under an Alternative Payment/Funding model whose duties would otherwise include provision of this service.

T13708 FP COVID-19 communication with specialist and/or allied care provider…….$40.00

Notes:

1. Payable to the Family Physician who participates in a 2 way telephone or videoconference communication with a specialist and/or allied care provider about a patient regarding COVID-19.
2. T13708 FP COVID-19 communication with specialist and/or allied care provider cannot be delegated. No claim may be made where communication is with a proxy for either provider.
3. Payable in addition to any visit fee on the same day.
4. Not payable for communications which occur as a part of the performance of routine rounds on the patient if located in a facility, or communications which occur as part of regular work flow within a physician’s community practice.
5. Not payable in addition to 14018 or 14077 on the same day for the same patient.
6. Not payable to physicians working under an Alternative Payment/Funding model whose duties would otherwise include provision of this service

• All face to face planning required under the FPSC planning fees (14033 Complex Care, 14075 Frailty, 14043 Mental Health, 14063 Palliative Care) may now be provided by Telehealth: video or phone.  Think of it as physician:patient planning.
• All existing time requirements remain the same: total planning time (30 minutes) and physician:patient  planning time (minimum 16 minutes)
• Mental Health Management fees (14044, 14045, 14046, 14047, 14048) already allow videoconferencing. This has been expanded to include telephone counselling.

• If the patient is able to independently use a phone and the physician feels that the encounter could be appropriately provided by Telehealth (video or telephone), then physicians will bill their face to face Long Term Care facility fee 00114 and include the claim note record “service provided via Telehealth”.
•  If the patient cannot independently use a phone (eg. due to dementia, hearing loss etc.)  or does not have their own phone, the physician  may review the patient’s medical status and any problems by telephone with an RN/LPN at the LTC facility, and bill the visit using 00114 and include the claim note record “Service provided via Telehealth with RN/LPN.”

WorksafeBC and ICBC will permit Telehealth services (video and telephone) for anything that does not require a physical exam/assessment.

From WorkSafeBC:

• The requirement that telehealth fees must involve video technology has been
  expanded to include telephone.
• Use the telehealth fee codes as appropriate
• Document on the physician’s report (Form 8/11) that the service was provided via video technology or telephone

From ICBC:

• Physicians are encouraged to deliver necessary care to ICBC patients via
  telehealth (video or telephone)
• Use the telehealth fee codes as appropriate and make a notation in the patient record.
• The Physician Telephone Management Fee code can also be leveraged in appropriate cases, invoiced directly to ICBC as outlined in the ICBC Fee Guide.
• Initial visits for the evaluation of recent injuries sustained by your patients may be scheduled in-clinic on an as-needed basis.
• Initial and Reassessment visits for the preparation of requested reports should be rescheduled in support of reducing non-essential in-person visits.

Suspension of the Driver Medical Examination Reports:

• RoadSafetyBC is temporarily suspending the issuance of Driver Medical Examination Reports (DMER), along with any outstanding DMERs and other medical requirements, in response to the pressure on the medical community during the COVID-19 pandemic.
• Physicians are still asked to report the highest-risk medically compromised drivers to RoadSafetyBC through Section 230 of the Motor Vehicle Act, and are asked to do so with as much information as possible to enable swift action by the Superintendent.

BC Family Doctors has been advocating since mid-February for appropriate fees for physicians delivering in-person care for patients with suspected or active COVID-19 symptoms only.  We are pleased to announce that these temporary fees are now in effect.

These two new fees can be billed in addition to a telehealth service (video or telephone) on the same day for the same patient.  This applies whether the in-person visit is done by the same physician or another physician.

T13701 Office Visit for COVID-19 with test………………………………………….. 50.00
Notes:
i) Payable for patients with suspected or active COVID-19 symptoms only.
ii) COVID-19 testing must be performed.
iii) Not intended for providing general information on a viral infection, including COVID-19.
iv) Not payable in addition to any other office visits to the same physician to the
same patient, same day. 

T13702 Office Visit for COVID-19 without test ………………………………….  40.00
Notes:
i) Payable for patients with suspected or active COVID-19 symptoms only.
ii) Not intended for providing general information on a viral infection, including COVID-19.
iii) Not payable in addition to any other office visits to the same physician for
same patient, same day.

• • Billing changes have been made that allow telehealth fee codes to be used when the service is rendered over the telephone or by using video technology.
  • These fee codes can be utilized for all patients for all medical concerns, including but not limited to COVID-19.  (i.e. if you are discussing diabetes care, you can use ICD-9 code 250.)
  • There are no daily volume limits for the telehealth fee codes.

  We have summarized the main fee codes that apply to telehealth services here.  

  See MOC here.

• The usual daily volume limits for family medicine office visits, office counselling and office complete examinations are suspended.
• See MOC for more information.

• Services directly related to COVID-19 should include diagnostic code C19.