This document provides information on various billing codes related to chronic disease management, prevention, mental health, and hospital visits. It discusses codes for complex care fees, telephone consultations, attachment fees, chronic disease management bonuses, and hospital visit fees. Requirements and limitations are outlined for billing each fee code. High level prevention guidelines and screening recommendations are also summarized.

1. CDM
This item may only be billed after one year of care has been provided and
the patient has been seen at least twice in the preceding 12 months or
the patient has received 12m of “guideline/FSFP” care.
Other flow sheets can be used if they are consistent with the BC
clinical guidelines for diabetes, heart failure, and/or essential
hypertension management.
This program is to the usual process of random audit through the
Ministry of Health’s Billing Integrity Program. Therefore, it is
important that you keep all of your completed patient flow sheets on
file.

2. Prevention Guidelines
• The "Routine or periodic physical examination” on the well
patient with no underlying medical conditions is not covered
by MSP.
• For patients with chronic illness where guideline informed
care recommends periodic complete examinations, such as
with diabetes, CHF, etc., a CPX is billable. (2 x yr with note)
• Healthy patients still need periodic partial examinations as
per prevention/screening recommendations.

3. Prevention Guidelines
•
•
•
•
•
•
•
•
•
Colorectal Cancer hemoccult test q1-2 yrs starting age 50
Mammogram/Pap smears
Hypertension screening
Hyperlipidemia screening, males>40, female>50 or if risk sooner
DM screening, fbs q3yrs >40 yrs, sooner if risk
ASA discussion if at risk
Smoking cessation
Diet modification
Exercise recommendations if cvs or dm risk

4. Prevention Fee (14066)
•
•
•
•
Smoking…(use icd9 code) 786
Physical inactivity…785
Medical obesity..783
Unhealthy eating…783
• In high risk patients a review every year may be appropriate
and so this may be billed on the same patient every year.
Billing tip: Keep an ongoing yearly list to max out
billings, 100/year only.

5. Drivers Medical examinations
 Commercial Driver exams and exams for 80+ years old must pay
privately for exam (fee code A00055 if complete exam, A00056 if
“partial examination” only)
 Those for “Drivers with Disability” (eg. Diabetes) may bill part to
OSMV and part to patient for full BCMA value
o 96220 – Driver’s Medical Examination Report (DMER) = $75 to OSMV
o 96221 – Diabetic (professional) Driver Report – stand-alone = $75 to OSMV
o 96222 – Diabetic (professional) Driver Report plus DMER = $30 to OSMV (for
total $105)
BCMA rate set April 1 each year – balance bill difference to patient accepted by
OSMV and MSP as this is not a “medically necessary” service.
5

7. 2013 5 new initiatives
• Frail complex patients not meeting CCF criteria.
• Unattached “1st visit” high needs complex patients.
• Telephone calls to patients.
• Telephone calls to facilities.
• New hospital initiatives.

8. Attached practice 14070
• You confirm the doctor patient relationship, by billing a zero sum
billing code --14070 --yearly to MSP.
• You provide FSFP services and will for the duration of the calendar
year.
• Membership to a division not required, but you need to contact
your local division to share your contact information and your
desire to participate with the initiatives to develop community-
specific supports as you are able.

9. Confirming doctor patient relationship.
As your family doctor, my practice team and I will:
• Provide you with the best care that we can
• Coordinate any specialty care that you need
• Offer you timely access to care within the best of our ability
• Maintain an ongoing record of your health
• Keep you up-to-date on any changes to the services offered at our office
• Communicate with you honestly and openly to address your health care
needs.

10. Confirming doctor patient relationship.
As my patient, I ask that you:
• Seek your health care from me and my team whenever possible
• Identify me as your doctor if you have to visit an emergency facility or other
health care provider, so they can provide me with information about your
treatment for your medical record
• Communicate with me honestly and openly so that we can best address your
health care needs.

11. How to bill for “Attached practice” fee code 14070
Submit fee item 14070 GP Attachment Participation Code
using the following “Patient” demographic information:
 PHN#: 975 303 5697
 Patient Surname: Participation
 First name: Attachment
 Date of Birth: January 1, 2013
 ICD9 code : 780

12. Attached practice 14070
NO need to call in each patient
Can be done face-to-face, by letter or other communication,
such as posting a standardized pamphlet in office and
examination rooms provided by the GPSC.
Supportive materials (posters, brochures) are available from the
GPSC website (www.gpscbc.ca)

13. 1) Frail complex patients not meeting CCF criteria.
New expanded CCF billing 14075.
• Attached practice.
• All patients with CSHA Clinical Frailty Scale score of
6 or more who do not already qualify for CCF.
• 14033 still available for those not participating in
attachment/division initiative.

15. S
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Help with all...
• S hopping
• H ousekeeping
• A ccounting
• F ood
• T ransport
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16. 2) Telephone calls to patients 14076
•
Attached practice.
•
$15 fee , max 500/year.
•
Not for appointments or referrals or refill of Rx.
•
New fee..phone call only..doctor/patient..not email.
•
May be delegated to another College-certified healthcare professional, not
moa.
•
14079 still applies..telephone or email.
•
Intent is to avoid a visit, to practice or WIC or ER. If office visit or house call
takes place the same day the 14076 will be rejected.

17. 3) Telephone calls to facilities and community 14077
• Attached practice. Any patient for whom FP is MRP.
• Replaces 14015, 14016, 14017 codes. Therefore must include start
and end time on the billing submission and should last greater
portion of 15 minutes in duration.
• $40/15min for phone call to a facility or community. Ex: calling ER to
give information on a patient being sent down, receiving phone calls
from hospital re: admission/updated condition/discharge.. Calls from
community by qualified personnel, calls to a nursing home > 8
minutes (otherwise bill 13005) ..
• Either side may initiate.
• Max 2/calendar day, up to max 18/calendar year per patient

18. 6 phone call fees…
phone call fees
14016/14077 Community Patient Conferencing, payable per 15 minutes
or greater portion thereof. Consult with specialist/other qualifier (ex: home
care or palliative care nurses, social workers)
1. Frail Elderly; (70yrs+) Diagnostic Code V15
2. Palliative Care; Diagnostic Code V58
3. End of Life; Diagnostic Code V58
4. Mental Illness; Appropriate Mental Health Diagnostic Codes
14079
(max 5/ 18months post billing) payable telephone/email
once 14033 (CCF) billed
or payable once 14043 (Mental Health) billed,
or payable once 14053 (COPD/CDM) is billed,
or End of life phone/email advice 14063 billed.
13005
Advise about a patient in community care. This fee is billable when
an allied health professional has contact with the FP.
14018 General Practice Urgent Telephone Conference with a Specialist

19. 4) Unattached high needs/complex patient Attachment Fee
14074
•
$200, in addition to a visit.
•
Commit to at least one year of care.
•
Target populations..
– frail of any age when accepted into practice or into residential care..
– significant cancer..
– severely disabled in the community..
– mental health and addictions..
– mother/baby (during pregnancy and up to 18m) dyads..
•
Need referral source.

20. Unattached Complex/High Needs Patient
Attachment fee 14074
Referral Sources
•
•
•
•
•
•
•
•
Acute Care: ER and Admitted
Mental Health/Substance Abuse Workers/Clinics
Home and Community Care
BC Cancer Agency or regional centers
Public Health
Medical director of nursing home.
Colleagues.. To be determined..? Thru DoFP
Local Division
Patients cannot self-identify

21. Attachment fee 14074
•
If there is a new FP taking over a practice of a doctor who is retiring/leaving,
the new FP is not eligible to bill G14074 on any existing patients of practice
as all practice infrastructure is already in existence, it is a transition only.
•
If there is no FP to take over a practice of a doctor who is retiring/leaving
and the leaving FP asks other FP(s) to take on these complex patients, GPSC
has agreed that this is an acceptable referral. FPs accepting transfers of
these patients will be able to bill the G14074 for eligible
patients. Alternatively, the patients could be referred to accepting FPs
through the locally determined unattached patient attachment process

22. Attachment fee 14074
•
The referrals do not need to be a lengthy written referral although it would be good to get the available
background information to the accepting FP up front, rather than expecting the MOA to chase
everything down.
•
However, the referral must come directly from the source, so it is not just the ER telling the patient they
need an FP and give them a list of who is accepting new patients.
•
GPSC is asking the local Divisions to discuss and develop a referral process that works for their
membership. The DoFP could even decide on something as simple as the ER/Hospital Discharge
Planning Team sending a list of patients (with PHN, contact info and diagnoses) as the patients are
referred to specific FPs from the list of FPs who have agreed to take these complex/High-needs patients
on.
•
There is no need to submit any electronic referral through MSP. The referral source must be
documented in the new patient chart.

23. Telephone calls to facilities 14077 vs. 13005
•
14077 replaces the 14015, 14016 & 14017. More flexibility as no patient diagnosis
restrictions or location restrictions as there were in the original 3 codes. 14077 can be
billed for a phone call at any stage of admission to Acute Care or any facility or
community. Time requirements are the same - 15 minutes or greater portion
thereof. Must put start and end times in bill.
•
14077 billing if FP is participating in Attachment and has submitted 14070 participation
code. If FP is not participating, then only has 13005 available regardless if simple/brief
or longer conferencing.
•
Fax or brief advice - use 13005.

24. 5) Hospital visits.
• 25% increase on 13008 & 00127 effective April 1, 2013
• Assigned Inpatient Care Network Initiative of $2100 per quarter for FPs
who maintain active privileges to care for their own patients in-hospital
new fee code 14086.
• Unassigned Inpatient Care Fee of $150 per patient. This fee will be
limited to FPs actively participating in the Unassigned Inpatient Care
Network initiative new fee code 14088.

25. 5) Hospital visits.
• 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; and
• Not payable to physicians working under salary, service
contract or sessional arrangements whose duties would
otherwise include provision of this care.

26. The benefits of attachment
bill 14070 1st
14074
Call facility
($40 x18/patient/yr)
14077
14070
14076
Unattached >>> attached ($200)
14075
CCF +++ ($315)
ET call home
($15x 500/doctor/yr)

27. complex care fee
code
14033
billable by most responsible doctor
billable any time once per calender year
value
cdm bonus fee still billable
$315
plus appropriate 0100/0101
use appropriate unique ICD9 code for CCF
visit
14079
$15
phone call
(max 5/18m) > CCF,COPD,PallIATIVE,MENTAL HEALTH
phone/e-mail, by physician only
unique ICD9 codes for either complex care fee
N414
N428
N250
N430
N585
N519
N573
I573
I428
I250
I430
I585
K573
Chronic neurodegenerative
Chronic neurodegenerative
Chronic neurodegenerative
Chronic neurodegenerative
Chronic neurodegenerative
Chronic neurodegenerative
Chronic neurodegenerative
Ischemic heart disease
Ischemic heart disease
Ischemic heart disease
Ischemic heart disease
Ischemic heart disease
CKD
Chronic liver Disease
Chronic liver Disease
CHF
DM
Cerebrovascular Disease
Chronic Kidney Disease
Chronic Liver Disease
phone/conferencing fees
14016
use ICD9
H250
H430
H585
H573
D430
D585
D573
C585
C573
R414
R428
R250
R430
R585
Ischemic heart disease
CHF
DM
Cerebrovascular Disease
Chronic Kidney Disease
Chronic Resp Disease
CHF
DM
CHF
Cerebrovascular Disease
CHF
Chronic Kidney Disease
CHF
Chronic Liver Disease
DM
Cerebrovascular Disease
DM
Chronic Kidney Disease
DM
Chronic Liver Disease
Cerebrovascular Disease Chronic Kidney Disease
Cerebrovascular Disease CLD liver disease
Chronic Resp Disease Ischemic Heart Disease
Chronic Resp Disease CHF
Chronic Resp Disease DM
Chronic Resp Disease Cerebral Vascular Disease
Chronic Resp Disease CKD
Attachment + phone calls
14070
attachment code yearly "0" sum
coordination of care for community based patients
conferencing with 1 other health care provider
14077
14076
$40 per greater portion of 15 minutes/max 4 per day/ 6 per year per patient 14075
14074
V15...frail elderly, 70yrs plus
V58…palliative care, end of life care
14018
XXX…complex mental illness
14079
YYY…complex comorbidity, 3 serious diseases
14016
13005
facilty phone call $40 max 18 per patient per year
$15 phone home for medical problem if patient attacfhed max 500/yr
CCF+ ++
unattached to attached bonus if referred
urgent phone consult with specialist ..(no visit to follow in 24hrs to spec/er)
$15
(max 5/18m) > CCF,COPD,PallIATIVE,MENTAL HEALTH
$40
coordination of care
~$15
CDM $125 DM (14050)/CHF (14051)/COPD (14053)..BP (14052) $50 . DM, COPD, and CHF may all be billed in same year, BP can be combined with COPD
Palliative Care 14063 $100 (+0100 if >30mins. or 0120 if >50mins.)…
Prevention Fee $50 bonus (14066) + 0100/0101/any age/medical obesity (783) /unhealthy eating (783) / physical inactivity(785) /smoking(786)
GP Mental Health Fees
14043
$100
14079
$15
GP Mental Health Planning Fee
phone call 5/18m
>>>>
>>>>>
>>>>>
once patient b illed 4* 0120 for the calender year, may bill 4 additional following fee codes per year
14044 4/yr
(=00120 $)
GP Mental Health Care Management fee (ages <50)
14045
14046
14047
14048
(=00120
(=16120
(=17120
(=18120
GP Mental
GP Mental
GP Mental
GP Mental
bill appropriate 0100/0120 in addition to 14043 if visit > 30 minutes
30 minutes visit, bill 14043 only
33-50 minute visit, bill 0100+14043
>50 minutes visit, bill 14043 +0120
4/yr
4/yr
4/yr
4/yr
$)
$)
$)
$)
•13228 w eekly/per patient
Health
Health
Health
Health
Care
Care
Care
Care
Management fee
Management fee
Management fee
Management fee
for hospital visit /associate status
•13339 1st patient of the day in addition to 13228
(ages 50-59)
(age 60 - 69)
(age 70 - 79)
(age 80+)
13070
2nd billing if WCB billed 1st & msp issue arises
13075
2nd billing if ICBC billed 1st & msp issue arises

28. DM Rx algorithm
•For younger patients with no pre-existing CVD or other
significant risk factors (hypertension, smoking, family history of
CVD, target an A1C below 7% (especially if it can be easily
achieved).
•For older patients (> 50 years), with a longer duration of
diabetes (> 15 years), target an A1C of ~7%. This target will
avoid the potential downsides of intensive therapy (such as
hypoglycemia and possible increased CVD risk), while still
providing protection against microvascular disease.
•For patients with significant comorbid illness and a limited life
expectancy, target a higher A1C 7.5-8% or higher.

29. *
Insulin
Initiation
Issues
Self-Titration of Insulin
Insulin Dosage Instructions..for patient
• Your target fasting blood sugar level is between 7-8 mmol/L
• You will inject 10 units of insulin each day..for 3 evenings.
• You will continue to increase by 1 unit every evening (or
every 2-3 evenings) until your blood sugar level is between
7-8
mmol/L before breakfast
• Do not increase your insulin when your fasting blood sugar
is 7 mmol/L
Gerstein HC, et al. Diabet Med 2006;23(7):736–42
Canadian Diabetes Association Clinical Practice Guidelines.. Can J Diabetes 2008;32(Suppl 1): Appendix 3.