Top 10 Billing Tips Increase your billings without breaking the rules Dr Hamish Hwang

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Bill for everything that you do Rule Number 1 Bill for everything that you do

Don’t bill for anything that you didn’t do Rule Number 2 Don’t bill for anything that you didn’t do

Rule Number 3 Document!

Rule Number 4 Document!

Rule Number 5 Document!

Your friend the note record

Top 10 Tips

Bill for electronic wound monitoring Number 10 Bill for electronic wound monitoring 10006 Specialist Email Patient Follow-Up $10.10 Secure platform medeohealth.com Post-mastectomy Chronic wounds Ostomy follow up Remote patient Also supports video followup (70070/70077)

Bill 75% for re-prep and drape Number 9 Bill 75% for re-prep and drape Type the following into the note record: “Separate prep and drape payable at 75% as per surgical preamble” Eg. Sentinel lymph node biopsy and partial mastectomy Bill 07479 at 100% and 07473 at 75%

Bill for surcharges for scopes done after hours or on the weekend Number 8 Bill for surcharges for scopes done after hours or on the weekend Cannot be “scheduled” or “elective” Emergency only Can bill surgical surcharges 01210, 01211, 01212 and applicable call back 01200, 01201, 01202 only if procedure more than 45min Does not apply to “diagnostic” procedures, only “surgical” procedures

“Surgical” endoscopy procedures: Number 8 “Surgical” endoscopy procedures: 33374 colonoscopy with polypectomy 07460 sigmoidoscopy decompression volvulus 33321 Removal foreign material (upper GI) 33322 Therapeutic injection 33323 Stent or catheter 33324 Thermal coagulation 33325 Gastric polypectomy 33326 PEG tube 33329 Esophageal dilation

78717 Specialist Discharge Care Plan for Complex Patients $75.00 Number 7 78717 Specialist Discharge Care Plan for Complex Patients $75.00 For any inpatient stay 4 days or longer Now includes elective admissions Can be billed in addition to 71008 Download template: http://sscbc.ca/fees/discharge-care-plan-complex-patients-fee

Number 7

Number 7 Enter the form into your EMR or fill-in online and print Fax to GP’s office and give copy to patient Bill $75 for 5 minutes work

Doesn’t seem like much but it is 37% more Number 6 Bill 07006 instead of 07008 for non-operative management of emergency patients 07006 - $27.76 07008 - $20.28 Doesn’t seem like much but it is 37% more Bill twice per calendar week – can bill Sat, Sun and then Mon, Tue Eg, GI bleed, pancreatitis, SBO, cholangitis

Number 5 Bill for repeat call backs and continuing care Call backs 01200, 01201, 01202 If you leave the hospital and come back a second time you can bill again Don’t bill if you haven’t actually left the hospital

Number 5 If you are called back and see multiple patients you can bill continuing care fees 01205, 01206, 01207 You have to be there more than 45min You must enter into the note record “CCFPP” (continuing care from previous patient) Eg, patient 1 1800-1830 07010 + 01200 Patient 2 1830-1900 07010 + 01205 ccfpp

Diagnostic and surgical procedures done together both billed at 100% Number 4 Diagnostic and surgical procedures done together both billed at 100% “Unless specified elsewhere or agreed to at the tariff committee etc, the general interpretation of Preamble B. 11. b is when a diagnostic procedure is performed with a surgical procedure the diagnostic procedure is paid at 100%. If more than one diagnostic procedure is performed with a surgery the 2nd diagnostic procedure is paid at 50%.”

Number 4 Eg 33374 colonoscopy/polypectomy + 10761 EGD Both 100% 10731 colonoscopy + 71689 hemorrhoid band 71535 lap Nissen + 10761 EGD

Number 3 Bill a hospital visit 07008 in addition to diagnostic procedures if last visit is more than 30 days ago Must enter into note record: “diagnostic procedure done more than 30 days after last visit” General Preamble D. 7. a. “A subsequent visit fee will be paid in addition to the procedure if more than thirty (30) days has elapsed between the initial visit or service and the diagnostic procedure.”

Does not apply if you do a “surgical” endoscopic procedure like 33374 Number 3 Does not apply if you do a “surgical” endoscopic procedure like 33374 Eg 10761 EGD 10763 biopsy 07008 hospital visit *note record 10731 colonoscopy

Number 3 10761 - $88.00 10731 - $227.15 07008 - $20.28 It’s like getting paid 23% more for an EGD and 9% more for a colonoscopy and is completely legit as long as you haven’t seen the patient for more than 30 days

10001 Urgent specialist advice - $60.00 Number 2 10001 Urgent specialist advice - $60.00 Bill for calls from GPs or ER for patients that you do not see the same day Need patient name, PHN, DOB and referring doctor – don’t be embarrassed to ask! Doesn’t matter if you are on call or not Best to record a brief note in your EMR Eg. “Spoke to Dr. X at 1500 on date. Patient with persistent rectal bleeding but stable. Plan: book direct for colonoscopy”

Number 1 Don’t forget to bill 07001 the age 75+ surcharge - $80.00 This is the number 1 underbilled fee The list of eligible fees is on the fee guide Don’t forget you can bill with sigmoidoscopy for volvulus 07460 and the “surgical” upper GI fees

Number 1

The order of the billing matters Number 1 The order of the billing matters 07001 always has to be in the 2nd slot with the code that is eligible for 07001 in the 1st slot Eg 33321 Removal foreign material 07001 Age surcharge 75+ 10761 EGD

BONUS TIP!!

Can keep on top of remittances and resubmissions Bonus Tip Do your own billing! My write-off rate is 0.75% Typically it is about 5% That’s $20K for an average income of $400K! Billing more accurate Can keep on top of remittances and resubmissions Familiarize yourself with the fee guide and billing rules

Bill for everything that you do Don’t forget Bill for everything that you do Don’t bill for anything that you didn’t do Document

QUESTIONS?

Please visit our website to download this presentation http://generalsurgeons.ca