1. Pain Management Billing

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

3. Pain Management Billing Family Physicians
MSP
Counseling (00120 series in office or 13018, telehealth)– used where there are significant emotional distress issues in addition to pain management
Maximum 4 services per year per patient (any combination of in-person or telehealth) – not restricted to patient’s own FP
Minimum 20 minutes, see preamble definition/requirements
Group Medical Visits (13763 [3 pts] – [> 20 pts])
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, including the management of malignant disease. Counselling, to be claimed as such, must not be delegated and must last at least 20 minutes.
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.
Start and end time must be entered in both the billing claims and patient’s chart.
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. Does “Chronic Pain” qualify as an eligible mental health diagnosis for the GPSC Mental Health Planning Fee?
Chronic Pain qualifies as an eligible mental health diagnosis only when it is present in association with a psychological condition (DSM , ). When chronic pain is present due only to a physical condition and without associated psychological condition(s), it does not qualify for the GPSC Mental Health Planning Fee (G14043).
In addition, if the Mental Health Planning Fee (G14043) is billed for a patient who does have an associated psychological condition, all other criteria of the G14043 Planning Fee must be met.

5. Pain Management with Adult Mental Health Billing
GPSC – fees restricted to FP accepting role of MRP for longitudinal coordinated care of patient for that calendar year
Mental Health Planning Fee (G14043)
Confirmed eligible diagnoses only (see appendix of Billing Guide)
30 minutes planning visit – majority must be face to face. No start/end time requirements, but must document time spent in chart.
May also bill or if service provided in addition to the planning service
Mental Health Management (G – Counseling Equivalent – age related)
Maximum 4 services per year per patient once four MSP counseling (in person or telehealth) used up – restricted to patient’s FP who billed G14043
May be provided in person or via videoconferencing (telehealth)
Same preamble requirements as 00120
Patient Telephone/ Follow-up fees (G14076; G14078)
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 eligible diagnosis (see appendix of Billing Guide) 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. 
Care Plan requires documentation of the following core elements in the patient’s chart:
1. There has been a detailed review of the case/chart and of current therapies therapies;
2. Name and contact information for substitute decision maker;
3. Documentation of eligible condition(s);
4. There has been a face-to-face planning visit with the patient, or the patient’s medical representative if appropriate, on the same calendar day that Care Planning Incentive code is billed;
5. Specifies a clinical plan for the patient’s care for the next year;
6. Documentation of patient’s current health status including the use of validated assessment tools when available and appropriate to the condition(s) covered by the care planning incentive;
7. Incorporates the patient’s values, beliefs and personal health goals in the creation of the care plan;
8. Outlines expected outcomes as a result of this plan, including advance care planning when clinically appropriate;
9. Outlines linkages with other allied care providers who would be involved in the patient’s care, and their expected roles;
10. Identifies an appropriate time frame for re-evaluation of the plan;
11. Provides confirmation that the care plan has been created jointly and shared with the patient and/or the patient’s medical representative and has been communicated verbally or in writing to other involved allied care providers as appropriate. The patient & or their representative/family should leave the planning process knowing there is a plan for their care and what that plan is.
*Telephone/ Follow-up fees –
Telephone and other non-face-to-face ‘visits’ or ‘touches’ are a standard component of workflow in other jurisdictions. They have been shown to significantly improve efficiency of care and therefore practice capacity.
The intent is to avert the need for a patient to be physically seen in the practice in order to increase access for other patients and/or to address urgent problems to avert a patient visit to an urgent care facility or Emergency Department.
They can be used at the discretion of the Family Physician for any patient for whom that Family Physician has assumed the Most Responsible Physician role for any clinical reason that addresses the intent above. Access to G14076 and G14078 are also available for family physicians who are members of a GP Maternity Network or a GP Unassigned Inpatient Network and who provide care to patients who are not attached to them in the community, but who may be cared for in a shared care manner with the patient’s community Family Physician.
G14076 GP Patient Telephone Management Fee - requires a clinical telephone discussion between the patient or the patient’s medical representative and physician or College-certified allied care provider (eg. Nurse, Nurse Practitioner) employed within the eligible physician practice – “telephone visit”.
G14078 G{ /Text/Telephone Medical Advice Relay Fee - This fee is payable for 2-way communication of medical advice from the physician to eligible patients, or the patient’s medical representative, via /text or telephone relay. Task of relaying physician advice may be delegated to medical office staff – MOA or ACP employed within the practice.

6. Does Substance Abuse and/or Addictions qualify as an eligible mental health diagnosis for the GPSC Mental Health Planning Fee?
Both Alcohol Dependency (303) and Substance Abuse (non-nicotine) (304) qualify as eligible mental health diagnoses. If the Mental Health Planning Fee (G14043) is billed for a patient with either Alcohol or Substance abuse issues, all other criteria of the G14043 Planning Fee must be met.