British Columbia is facing two concurrent public health emergencies: the COVID-19 pandemic and the ongoing opioid overdose crisis. We agree with the BC Centre on Substance Use who has stated: “Extraordinary measures are needed to support people who use drugs (including alcohol) and prevent ongoing community spread of COVID-19 among a vulnerable, often immune-compromised population.”
Fee Code Change
We have been advocating for several fee code changes (and new fee codes/APP funding) to support physicians doing complex, necessary and time-intensive patient care with people who use drugs. As a result of this work with the Ministry of Health and Doctors of BC, we are pleased to announce the first of those fee code changes, effective July 23, 2020.
Temporary changes noted in red.
00039 Management of Maintenance Opioid Agonist Treatment (OAT) for Opioid Use Disorder
- The physician does not necessarily have to have direct face-to-face contact with the patient for this fee to be paid.
- 00039 is not the only fee payable for any medically necessary service associated with maintenance opioid agonist treatment for opioid use disorder. This includes but is not limited to the following:
- At least one visit (in-person, telephone or video conference) per month with the patient after induction/stabilization on opioid agonist treatment is complete.
- At least one in-person visit with the patient every 90 days. Exception to this criterion will be considered on an individual basis.
- Supervised urine drug screening and interpretation of results.
- Simple advice/communication with other allied care providers involved in the patients OAT.
- Claims for treatment of co-morbid medical conditions, including psychiatric diagnoses other than substance use disorder, are billable using the applicable visit or service fees. Counselling and visit fees related only to substance use disorder are not payable in addition with the exception of visits required to support Substance Use Risk Mitigation in the context of COVID-19 (claim note record must indicate “COVID-19 risk mitigation”).
- This fee is payable once per week per patient regardless of the number of services per week for management of OAT maintenance.
- This fee is not payable with out of office hours premiums.
- Eligibility to submit claims for this fee item is limited to physicians who are actively supervising the patient’s continuing use of opioid agonist medications for treatment of opioid use disorder.
- This payment stops when the patient stops opioid agonist treatment.
What is “Substance Use Risk Mitigation in the context of COVID-19”?
The BC Centre on Substance Use (BCCSU) has provided interim clinical guidance to health care providers about how to assist with risk mitigation in the context of dual public health emergencies. This guidance aims to support individuals who may be at increased risk of overdose, withdrawal, craving, and other harms related to opioids, stimulants, benzodiazepines, tobacco and alcohol.
There is also updated Opioid Agonist Treatment (OAT) guidance to ensure patients can access needed medications while reducing COVID-19 related risks, during this extraordinary period of dual public health emergencies.
A 24/7 Addiction Medicine Clinician Support Line has been created to connect physicians to an Addiction Medicine physician who can assist with screening, diagnostic clarification, medication recommendations and treatment planning.
Support is available for a wide range of substance use concerns such as opioids, alcohol, stimulants, and benzodiazepines. If the fee code requirements are met, physicians may be able to bill 14018 or 14077 for the discussion.
Additional fee code changes as well as alternate payment models are needed to better care for the patient population that is most affected by both public health emergencies. We will continue to work with our partners at the BC Centre on Substance Use, Doctors of BC, and the Ministry of Health to improve fee codes and funding models for substance use care as well as the overall system of care.