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 (in office 00120/telehealth 13018, 13038)
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
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])
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)
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 (any combination of 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.
G14079 deleted effective October 1, 2017
* G14079 – deleted effective October 1, 2017

5. Child/Youth Mental Health Billing Family Physicians
G14076 GP Patient Telephone Management Fee:
Access requires submission of GPSC Portal Code G14070 (G for locums) or registration in a Maternity Network or Unassigned Inpatient Network
$20 per 'visit'
All patients for whom that FP is community MRP
1500 per physician per calendar year limit (including locums)
Intent is to use to avert need for a visit; in practice, WIC, ER
Requires clinical discussion. NOT to be used for prescription renewals, anti-coagulation therapy by telephone (00043) or notification of appointments or referrals
May be delegated to another College-certified healthcare professional employed within the practice, who has clinical scope of practice to provide advice directly to patient without physician oversight (eg LPN, RN, NP, Social Worker – Excludes MOA)
GPSC fees cannot be correctly interpreted without reading the GPSC Preamble NOTES:
Payable only to Family Physicians who have successfully:
Submitted the GPSC Portal Code G14070 or on behalf of Locum Family Physicians who have successfully submitted the GP Locum GPSC Portal Code G14071 on the same or a prior date in the same calendar year; or
Registered in a Maternity Network or GP Unassigned In-patient network on the same or a prior date in the same calendar year.
Telephone Management requires a clinical telephone discussion between the patient or the patient’s medical representative and physician or College-certified allied care professionals (e.g. Nurse, Nurse Practitioner) employed within the eligible physician office.
Chart entry must record the name of the person who communicated with the patient or patient’s medical representative, as well as capture the elements of care discussed.
Not payable for prescription renewals, anti-coagulation therapy by telephone (00043) or notification of appointments or referrals.
Payable to a maximum of 1500 services per physician per calendar year.
G14077 payable for same patient on same day if all criteria are met. Time spent on telephone with patient under this fee does not count toward the time requirement for the G14077.
Not payable on the same calendar day as a visit or service fee by same physician for same patient with the exception of G14077.
Not payable on the same calendar day as G14078.
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.
Last updated: April 2018

6. Child/Youth Mental Health Billing Family Physicians
G14078 GP /Text/Telephone Medical Advice Relay Fee (implemented October 1, 2017):
Access requires submission of GPSC Portal Code G14070 (G for locums) or registration in a Maternity Network or Unassigned Inpatient Network
$7 value (roughly equivalent to anti-coagulation therapy by telephone)
All patients for whom that FP is community MRP
200 per physician per calendar year limit (including locums)
Requires two-way communication to relay medical advice from FP by , text or phone between the patient or the patient’s medical representative and this task may be delegated to another College-certified healthcare professional (eg LPN, RN, NP, Social Worker) or MOA employed within the practice.
NOT to be used prescription renewals, anti-coagulation therapy by telephone (00043) or notification of appointments or referrals
GPSC fees cannot be correctly interpreted without reading the GPSC Preamble NOTES:
Payable only to Family Physicians who have successfully:
Submitted the GPSC Portal Code G14070 or on behalf of Locum Family Physicians who have successfully submitted the Locum GPSC Portal Code G14071 on the same or a prior date in the same calendar year; or
Registered in a Maternity Network or GP Unassigned In-patient network on the same or a prior date in the same calendar year.
Requires two-way communication to relay medical advice from FP by , text or phone between the patient or the patient’s medical representative and physician or medical office staff employed within the eligible physician office.
Chart entry must record the name of the person who communicated with the patient or patient’s medical representative, as well as capture the elements of care discussed.
iv) Not payable for prescription renewals, anti-coagulation therapy by telephone (00043) or notification of appointments or referrals.
Payable to a maximum of 200 services per physician per calendar year.
G14077 payable for same patient on same day if all criteria are met. Time spent on telephone with patient under this fee does not count toward the time requirement for the G14077.
Not payable on the same calendar day as a visit or service fee by same physician for same patient with the exception of G14077.
Not payable on the same calendar day as G14076.
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.
Last updated: April 2018

7. 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.

8. 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
GP Allied Care Provider 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.
GP Allied Care Provider Conferencing Fee (G14077)
 Conferencing with at least one other health professional (includes physicians) – by telephone or in person
 Regarding 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 with patient on same day
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.