CDM – Heart Failure 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

Mrs. G.

Mrs. G. – Heart Failure Mrs. G. had history of heart failure for the previous 4 years, which was treated with intermittent diuretics, Beta blocker and ACE-I. A coronary angiogram in 1997 was negative for CAD and valvular disease, and the EF was 30%. Subsequent echos showed progressive left ventricular dysfunction with left ventricular enlargement and global hypokinesis. In addition, she had a history of nonsustained ventricular tachycardia and sudden syncopal attacks. She has developed non-insulin dependant DM.

What other CDM codes can be billed with 14051? Payable in addition to items G14050 or G14053 for the same patient if eligible. 14051 An annual incentive fee payable to the most responsible physician (MRP) for having provided a year of evidence-informed care to a patient with heart failure. It is acknowledged that the patent's values & comorbidities, as well as applicability of guideline recommendations to the patient’s particular clinical context, should be taken into account. GPSC fees cannot be correctly interpreted without reading the GPSC Preamble NOTES: 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 heart failure and the documented provision of a clinically appropriate level of guideline-informed care for heart failure 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).This visit requirement excludes procedures, laboratory and X-ray services. 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 G14251. Claim must include the ICD-9 code for heart failure (428). Payable once per patient in a consecutive 12 month period. 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. 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.