CDM – COPD Billing

Billing Support Tools www.sgp.bc.ca Everything covered today is on the SGP or GPSC websites: www.sgp.bc.ca http://www.gpscbc.ca/billing-guide-fees

Mr. A.

Mr. A. - COPD A 69 year old patient with a history of smoking and who meets the clinical criteria for COPD. He continues to smoke and has had spirometry done two years ago to confirm COPD. He comes in for an inhaler renewal.

What are the minimum requirements to bill a 14053? When can you bill this code? Payable to the family physician who is the most responsible for the majority of the patient's longitudinal general practice care. Applicable only for patients with documentation of a confirmed diagnosis of COPD and the documented provision of a clinically appropriate level of guideline-informed care for COPD in the preceding year. This item may only be billed after one year of care has been provided and the patient has been provided at least two visits in the preceding 12 months. Office, prenatal, home, long term care visits qualify. One of the two visits may be a telephone (G14076, G14079 ) or group medical visit (13763-13781). Not payable if the required two visits were provided while working under salary, service contract or sessional arrangement. If applicable, bill your incentive under fee item G14253. Claim must include the ICD-9 code for heart failure (496). Payable once per patient in a consecutive 12 month period. Payable in addition to fee items G14050, G14051 or G14052 for same patient if eligible. Not payable once G14063 has been billed and paid as patient has been changed from active management of chronic disease to palliative management. If a visit is provided on the same date the incentive is billed; both services will be paid at the full fee. Successful billing of the Annual Chronic Care incentive for COPD (G14053) allows access to 5 Telephone/E-mail follow-up fees (G14079) per calendar year over the following 18 months. It is acknowledged that patent’s values & comorbidities, as well as applicability of guideline recommendations to the patient’s particular clinical context, should be taken into account in their care. It is not mandatory to use official GPAC flow sheets, however it is important to document the elements of guideline-informed care If you wish to use a GPAC flowsheet, one can be downloaded here: GPAC COPD Flowsheet. Documentation of the provision of patient self-management supports as part of the patient’s chronic disease management is expected. Patient self-management can be defined as the decisions and behaviors that patients with chronic illness engage in that affect their health. Self-management support is the help given to patients with chronic conditions that enables them to manage their heath on a day to day basis. An important part of this support is the provision of tools by the family physician that can enable patients to make appropriate choices and sustain healthy behaviors. There are a variety of tools publically available (eg. health diaries/passports, etc.) to help build the skills and confidence patients need to improve management of their chronic conditions and potentially improve outcomes. Last updated: September 8, 2015

Note that COPD can be billed with any other chronic condition, HTN can only be billed with COPD. DM and Heart Failure can be billed together.