1. MSP 00121, 00122, 13763 - 13781 Billing Codes Group Medical Visits
MSP 00121, 00122,
Billing Codes
for
Group Medical Visits

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

3. The Geriatric Group Visit

4. Geriatric Group Visit
Blouw is a general practitioner and she consults in geriatric psychiatry. She has many patients with dementia, so she decided to start holding group sessions for them. Her first sessions had six to eight patients per visit, along with one or two caregivers per patient. Each monthly session features a speaker, such as a dietician, occupational therapist, mental health expert, or pharmacist.
The group visits are held in a large, central space at the community healthy living centre, and snacks are served. First, confidentiality agreements are signed; then there is a presentation from the speaker. Blouw then holds a round-table discussion to find out how things are going for each patient, and there is time for questions, medical checks, and prescription renewals.
“At first, it was tough to adjust to the group setting with patients,” says Blouw. “I’m used to doing things one-on-one in a closed office. But after doing a couple, I see that the group dynamic is working better than I expected, and I’m getting used to it. The participants are very comfortable discussing their issues together.”
The patients in Blouw’s group have mild to moderate dementia. “They are all very respectful of each other, and there is good interaction, lots of interest, and positive feedback,” she says.
Kim De Sensi has been bringing her father to Blouw’s group visits and finds they offer a different level of interaction.
“At first, I wasn’t sure what the group visit was about, but by the second one, we were sharing medical information and feeling completely comfortable about that,” says De Sensi. “The speakers offer great information, and this is definitely more medical than my usual caregiver support group. I’m glad to see new stuff like this.”

5. Preamble
What do you have to document to bill a (first full hour) and (second hour, per ½ hour or major portion thereof)?
Preamble D Group Counselling
The group counselling fee items found in the General Practice and various specialty sections of the Schedule apply only when two or more patients are provided counselling in a group session lasting 60 minutes or more.
The group counselling fee items are not applicable when there is a discussion with the patient in the presence of a caregiver, spouse, or relative when the patient is the only person requiring medical care. In those situations, only the applicable individual counselling fee item could be billed, using the patient’s MSP personal health number.
Group counselling fee items are not billable for each person in the group. Claims should be submitted under the Personal Health Number of only one of the beneficiaries, with the names of the other patients attending the session listed in the note record.
Only patients with valid MSP coverage should be included.
Times should be included with billings for group counselling fee items.
Last updated: March 4, 2014

6. Charge per Patient, per ½ hour or Major Portion Thereof
P13763 – code for 3 – 20 patients
P13781 (per pt) code for greater than 20 patients
Not appropriate for advice relating to a single patient.
It applies only when all members of the group are receiving medically required treatment
General Overview:
A Group Medical Visit provides medical care in a group setting. A requirement of a GMV is a 1:1 interaction between each patient and the attending physician. While portions of the GMV may be delegated to other allied health providers, the physician must be physically present at the GMV for the majority of each time interval billed and assumes clinical responsibility for the patients in attendance. Because this is a time based fee, concurrent billing for other services during the time intervals billed for GMV is not permitted.
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.
Fees are per patient, per 1/2 hour or major portion thereof.
NOTES:
A separate claim must be submitted for each patient.
When a patient attends a group visit, it should be noted in his or her chart, along with the start and end times.
A separate file should be maintained which documents all participants in each group visit.
Claim must include start and end times.
Not payable to physicians working under salary, service contract or sessional arrangements, and whose duties would otherwise include provision of care.
A minimum of a full thirty (30) minute period and a maximum of ninety (90) minutes may be claimed per patient per day.
Where group clinical visits with a patient extend beyond two and one-half (2 ½) hours in any seven (7) day period, a note-record is required.
Service is not payable with other consultation, visit or complete examination services, for the same patient, on the same day.
Concurrent billings for any other MSP services for any patient during the time interval for which the GMV fee is billed will not be paid.
Where two physicians are involved, the group should be divided for claims purposes, with each physician claiming the appropriate rate per patient for the reduced group size. Each claim should indicate "Group clinical visit" and also identify the other physician.
Last updated: April 27, 2017