1. CDM – Hypertension Billing

2. Billing Support Tools www.sgp.bc.ca
Everything covered today is on the SGP or GPSC websites:

3. Mr. P.

4. Mr. P. - Hypertension
A 49 year old moderately obese patient is here for his routine blood pressure follow-up. You have been monitoring his blood pressure at his last 3 visits; his average has been 154/90. He is on 2.5mg of an ACE-I daily.

5. What are the minimum requirements to bill a 14052?
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 hypertension and the documented provision of a clinically appropriate level of guideline-informed care for hypertension 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 (14076, 14079) or group medical visit ( ). This visit requirement excludes procedures, laboratory and X-ray services.
Claim must include the ICD-9 code for hypertension (401).
Not payable if 14050, paid within the previous 12 months.
An annual incentive fee payable to the most responsible physician (MRP) for providing a year of evidence-informed care to a patient with hypertension. 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:
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 ( ). 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 G14252.
Payable once per patient in a consecutive 12 month period.
Not payable if G14050, G14250, G14051, G14251 paid within the previous 12 months.
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

6. 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.