1. Child/Youth Mental Health
Billing
Child/Youth Mental Health

2. www.gpscbc.ca Billing Support Tools
Everything covered today is on the SGP or GPSC website:

3. Child/Youth Mental Health Billing Family Physicians
MSP
Counseling (00120)
Maximum 4 services per year per patient – not restricted to patient’s own FP
Minimum 20 minutes, see preamble definition/requirements
Office Visit (00100)
For follow-up that does not meet Pre-amble requirements of counseling (time &/or nature of visit)
Group Medical Visits (13763 [3 pts] – [> 20 pts])
New sliding scale based on number of patients billed per patient
Billed per ½ hour or greater portion to max of 3 units per patient
Removes individual face-to-face “service” requirement
Not included in HVLIP cap calculations
Counselling
Counselling is defined as the discussion with the patient, caregiver, spouse or relative about a medical condition which is recognized as difficult by the medical profession or over which the patient is having significant emotional distress (not coping). Counselling, to be claimed as such, must not be delegated and must last at least 20 minutes. Document patient coping/emotional distress in chart as well as total time of visit. Start and end time must be entered in both the billing claims and patient’s chart.
Counselling is not to be claimed for advice that is a normal component of any visit or as a substitute for the usual patient examination fee, whether or not the visit is prolonged. For example, the counselling codes must not be used simply because the assessment and/or treatment may take 20 minutes or longer, such as in the case of multiple complaints. The counselling codes are also not intended for activities related to attempting to persuade a patient to alter diet or other lifestyle behavioural patterns. Nor are the counselling codes generally applicable to the explanation of the results of diagnostic tests.
Not only must the condition be recognized as difficult by the medical profession, but the medical practitioner’s intervention must of necessity be over and above the advice which would normally be appropriate for that condition. For example, a medical practitioner may have to use considerable professional skill counselling a patient (or a patient’s parent) who has been newly diagnosed as having juvenile diabetes, in order for the family to understand, accept and cope with the implications and emotional problems of this disease and its treatment. In contrast, if simple education alone including group educational sessions (e.g.: asthma, cardiac rehabilitation and diabetic education) is required, such service could not appropriately be claimed under the counselling listings even though the duration of the service was 20 minutes or longer. It would be appropriate to apply for sessional payments for group educational sessions. Unless the patient is having significant difficulty coping, the counselling listings normally would not be applicable to subsequent visits in the treatment of this disease.
GENERAL PRACTICE GROUP MEDICAL VISIT
A Group Medical Visit provides 1:1 patient care in a group setting. Group Medical Visits are an effective way of leveraging existing resources; simultaneously improving quality of care and health outcomes, increasing patient access to care and reducing costs. Group Medical Visits can offer patients an additional health care choice, provide them support from other patients and improve the patient-physician interaction.
Physicians can also benefit by reducing the need to repeat the same information many times and free up time for other patients. Appropriate patient privacy is always maintained and typically these benefits result in improved satisfaction for both patients and physicians.
The Group Medical Visit is not appropriate for advice relating to a single patient. It applies only when all members of the group are receiving medically required treatment (i.e. each member of the group is a patient).
The GP Group Medical Visits are not intended for activities related to attempting to persuade a patient to alter diet or other lifestyle behavioural patterns other than in the context of the individual medical condition.
Unlike previous billing of 00100, all of which counted toward the HVLIP cap of 50 patients per day, the new fee scale does not. It is consistent with the psychiatric group psycho-therapy and the SSC specialist group medical visit schedule.

4. Child/Youth Mental Health Billing Family Physicians
GPSC – fees restricted to FP accepting role of MRP for longitudinal coordinated care of patient for that calendar year
Mental Health Planning Fee (G14043)
Axis 1 diagnoses only
30 minutes face to face planning visit
If longer may also bill or depending on time and nature of service ( if up to 49 min; or if 50 min or more and fulfills counseling preamble requirements)
Mental Health Management (G – Counseling Equivalent – age related)
Maximum 4 services per year per patient once four used up – restricted to patient’s FP who billed G14043
Same preamble requirements as 00120
*Patient Telephone/ Follow-up fees (G14079)
This fee is payable upon the development and documentation of a patient’s Mental Health Plan for patients resident in the community (home or assisted living, excluding care facilities) with a confirmed Axis I diagnosis of sufficient severity and acuity to cause interference in activities of daily living and warrant the development of a management plan. 
This fee requires the GP to conduct a comprehensive review of the patient’s chart/history, assessment of the patient’s current psychosocial symptoms/issues by means of psychiatric history, mental status examination, and use of appropriate validated assessment tools, with confirmation of diagnosis through DSM IV diagnostic criteria. It requires a face-to-face visit with the patient and/or the patient’s medical representative. 
From these activities (review, assessment, planning and documentation), a Mental Health Plan for that patient will be developed that documents in the patient’s chart, the following: 
That there has been a detailed review of the patient’s chart/history and current therapies; 
The patient’s mental health status and provisional diagnosis by means of psychiatric history and mental state examination; 
The use of and results of validated assessment tools. The GPSC strongly recommends that these evaluative tools, as clinically indicated, be kept in the patient’s chart for immediate accessibility for subsequent review. Assessment tools such as the following are recommended, but other assessment tools that allow risk monitoring and progress of treatment are acceptable: 
a) PHQ9, Beck Inventory, Ham-D for depression;  b) MMSE for cognitive impairment;  c) MDQ for bipolar illness;  d) GAD-7 for anxiety;  e) Suicide Risk Assessment;  f) Audit (Alcohol Use Disorders Identification Test) for Alcohol Misuse; 
DSM-IV Axis I confirmatory diagnostic criteria; 
A summary of the condition and a specific plan for that patient’s care;
An outline of expected outcomes;
Outlined linkages with other health care professionals (Including Community Mental Health Resources and Psychiatrists, as indicated and/or available) who will be involved in the patient’s care, and their expected roles; 
An appropriate time frame for re-evaluation of the Mental Health Plan; 
That the developed plan has been communicated verbally or in writing to the patient and/or the patient’s Medical Representative, and to other health professionals as indicated. The patient and/or their representative/family should leave the planning process knowing there is a plan for their care and what that plan is. 
Following the successful billing of the Mental Health Planning fee, the GP will have access to 4 additional counselling equivalent mental health management fees per calendar year once the 4 MSP counselling fees have been billed.
Patient Eligibility:  • Eligible patients are community based, living in their home or assisted living. Facility based patients are not eligible. 
Requires documentation of the patient’s mental health status and diagnosis by means of psychiatric history, mental state examination, and confirmatory DSM IV diagnostic criteria. Confirmation of Axis I Diagnosis is required for patients eligible for the GP Mental Health Planning Fee. Not intended for patients with self limiting or transient mental health symptoms (e.g.: Brief situational adjustment reaction, normal grief, life transitions) for whom a plan for longer term mental health care is not necessary. 
Payable once per calendar year per patient. 
Payable in addition to a visit fee billed same day. 
Minimum required time 30 minutes in addition to visit time same day. 
G14016, Community conferencing fee payable on same day for same patient, if all criteria met. 
Not payable on the same day as G14044, G14045, G14046, G14047, G14048 (GP Mental Health Management Fees). 
G14079 GP telephone / management fee is not payable on the same day. 
Not intended as a routine annual fee if the patient does not require on-going Mental Health Plan review and revision. 
G14015, Facility Patient Conferencing Fee, not payable on same day for same patient as facility patients are not eligible. 
Not payable to physicians who are employed by or who are under contract to a facility and whose duties would otherwise include provision of this care. 
Not payable to physicians working under salary, service contract or sessional arrangements whose duties would otherwise include provision of this care.  Successful billing of the mental health planning fee (G14043) allows access to 5 Telephone/ follow-up fees (G14079) per calendar year.over the following 18 months.
*Telephone/ Follow-up fees – effective January 1, 2012 the previous 4 different telephone/ fees were simplified into a single fee code G14079 that is billable on any patient who has had one of the GPSC planning incentives or COPD CDM fee billed in the previous 18 months 14033, 14043, 14053, There is a limit of 5 services per patient regardless how many of the portal fees have been billed.
* G14079 – change Jan 1, 2011 – replaces all previous telephone fees – 14049, 14039, & 13073

5. Child/Youth Mental Health Billing Family Physicians (continued)
MSP – Non-face-to-face services
Telehealth Service with Direct Interactive Video Link with Patient
In Office – FP has equipment at office to provide service
P13037 Telehealth GP in-office Visit
P13038 Telehealth GP in-office Individual counselling (minimum time per visit – 20 minutes – up to 4 per calendar year)
P13041 – Group counseling of 2 or more patients first hour, P nd hour per ½ hr or greater portion – bill only on one patient
Out-of-Office – FP must go to HA facility to access equipment to provide service
P13017 Telehealth GP in-office Visit
P13018 Telehealth GP in-office Individual counselling (minimum time per visit – 20 minutes – up to 4 per calendar year)
13021 – Group counseling of 2 or more patients first hour, nd hour per ½ hr or greater portion – bill only on one patient
Advice about Patient “In Care” (13005)
For phone/fax requested by AHP for brief advice.
TELEHEALTH SERVICES
“Telehealth Service” is defined as a medical practitioner delivered health service provided to a patient via live image transmission of those images to a receiving medical practitioner at another approved site, through the use of video technology. “Video technology” means the recording, reproducing and broadcasting of live visual images utilizing a direct interactive video link with a patient. If the sending and/or receiving medical practitioner
are not in a Health Authority approved site, the medical practitioner is responsible for the confidentiality and security of all records and transmissions related to the telehealth service. In order for payment to be made, the patient must be in attendance at the sending site at the time of the video capture.
For FPs there are 2 sets of telehealth fee codes, depending on the location of the FP providing the service. If you have secure videolinking capability from the office, then the “in office” fees are billable. If you must go to a HA (or other) location to access the equipment to provide secure videolinked services, then the “or-or-office” fees are billable.
Advice about Patient “In Care” (13005)
Telephone Advice about patients “in care” initially brought in to compensate for phone/fax simple advice for patients in LTC. Patients under the care of a health authority/medical program (eg. Community mental health, home care, etc.) are considered to be “in care” for the purposes of this fee. Examples of simple advice may be side effect management, medication dose – not full conferencing about plan but very specific advice. Physicians not included as AHP for this MSP fee.

6. Child/Youth Mental Health Billing (continued)
GPSC – Conferencing Fees – restricted to FP accepting role of MRP for longitudinal coordinated care of patient for that calendar year
Community Patient Conferencing Fee (G14077)
per 15 min or greater portion, max 4 units per day, 6 units per calendar year
Conferencing by phone or in person with at least 1 allied health professional
Urgent Telephone Advice from a Specialist or GP with Specialty Training Fee (G14018) – call within 2 hours due to patient acuity
Telephone Advice Fees – Specialists (SSC – G1000X codes); GPs with Specialty Training (GPSC – G1402X codes)
G10001/G14021 – response within 2 hours
G10002/G14022 – response within 1 week
G10003/G14023 – telephone follow-up with patient
GPSC definition GPs with Specialty Training GPs who has specialty training and who provides services in that specialty area through a health authority supported or approved program.
Community Patient Conferencing Fee (G14077)
 Conferencing with at least one other health professional (includes physicians) – by telephone or in person
 Community patients: community based, living in their home, in assisted living facilities, or in group homes
 Payable in units of $40.00 per 15 minutes or greater portion for a total of 6 units per calendar year, max of 4 units on any one calendar day
 Compensates GP when conferencing for the creation of a coordinated clinical action plan for patients living in the community, with more complex needs, including patients with mental health conditions
 Not billable for simple advice about community patients (“in care”) when initiated by the community care worker (Bill 13005)
 Involving allied health professionals in the self-management process is billable under community patient conferencing fee (e.g. Bounce Back)
 Once goals and plan determined, communicating these with the allied health professionals involved in the patient care is appropriate; this may improve patient ability of attaining their goals
 May be billed in addition to MSP office visit or other GPSC fees
General Practice Urgent Telephone Conference with a Specialist (or GP with Specialty Training) Fee (G14018)
The intent of this initiative is to improve management of the patient with acute needs, and reduce unnecessary ER or hospital admissions/transfers. Conferencing on an urgent basis (within 2 hours of request for a telephone conference) with a specialist or GP with specialty training by telephone followed by the creation, documentation, and implementation of a clinical action plan for the care of patients with acute needs; i.e. requiring attention within the next 24 hours and communication of that plan to the patient or patient's representative.
This fee is billable when the patient’s condition requires urgent conferencing with a specialist or GP with specialty training, and the development and implementation of a care plan within the next 24 hours to keep the patient stable in their current environment.
This fee is not restricted by diagnosis or location of the patient, but by the urgency of the need for care.
Telephone Advice Fees
The Specialist Services Committee (SSC) developed fees to compensate specialists for giving telephone advice to other physicians and to patients. The GPSC funds the mirror fees for those GPs providing specialty services. For the purpose of these telephone advice fee items the GPSC has defined a General Practitioner (GP) with specialty training as: “A GP who has specialty training and who provides services in that specialty area through a health authority supported or approved program”. Telephone advice must be related to the field in which the GP has received specialty training.
These telephone advice fees do not reflect patient acuity, only response time. This has created a problem with the RACE programs where the specialty physician responds within 2 hours regardless of patient acuity, resulting in the giver or the advice billing the G10001 or G14021 but the requesting FP not being able to bill the if the advice could have been given in a longer time frame. GPSC is aware of this and will review its wording once future funding is determined. For patients eligible for the Community Patient Conferencing fee G14016 (eg. Mental health patients) there is an alternative if the advice from the specialist is not required in 2 hours due to acuity.