This is the first of our series of condensed guides on MSP billing. Today we cover billing for general internal medicine (GIM) practitioners.
MSP states that all new consultations require a written letter from the referring physician and that you (the attending) provide a written report on your findings to the referring physician within 2 weeks. In practice this isn't used for day-to-day billing, but your documentation would be required if you were to be audited.
You can bill a new consultation on a patient if a new condition arises during their stay. If you've already billed a new consult and a new condition arises you should bill a 00310. However, if your patient meets the criteria for complex conditions, you can bill a 00311 (3 new conditions) or a 32312 (2 new conditions).
00310 - New Consultation
Only paid once per 6 months, per diagnosis. That's across all physicians, so if another physician logged a New Consult (same billing code) for the same diagnosis (ICD9 code) in that 6 month interval you can't bill for it. Of course, you'll likely not know if this is the case, so it'll get rejected and we'll re-submit as a Limited Consult.
If the patient develops a new condition/diagnosis within that 6 month interval you can log a new consultation. MSP matches the billing code to the ICD9 code logged on the claim to determine if it is valid.
00312 - Repeat or Limited Consult
Log this when you're requested to do a consultation but a New Consultation has already been logged for that diagnosis in the past 6 months. Also logged if the Consult isn't as comprehensive as a Full Consultation and it doesn't warrant the full fee (ex: it's less effort).
There's no specific written timing rule for how often you can log a Limited Consult, however in our experience it'll get rejected if another Limited Consult has been logged within the previous 42 days. It's expected that a Limited Consult is logged as part of Continuing Care for a patient, but it must be requested.
00311 - Complex Consult (3 Conditions)
Paid once per patient, per hospital admission/visit and doesn't have the 6 month requirement of a 00310. Patient must have 3 of the listed medical conditions (we provide that ICD9 list when you select the code). Or in some circumstances, have only 2 conditions from the list and a third not on the list. In this case you must provide an explanation (in the Notes) of the medical necessity for the Complex fee code.
32312 - Complex Consult (2 Conditions)
Paid once per patient per 6 month period (unlike 00311 which is per admission). Patient must have 2 of the conditions from the list provided in the app when you select the code.
32308/32318 - Subsequent Hospital Visit (2 or 3 Conditions)
Requires that a 00311/32312 has been logged on the patient in the past 6 months. You can only log these claims for the first 10 days of hospitalization, thereafter you need to log a 00308. Our app prompts you when the 10 day period is up (provided the admission date was available on the label or it was entered by you when you added the patient).
You can see a patient multiple times (and bill for it) in a day if there's a medical necessity. Just indicate that in the notes.
32307/32317 - Sub Office Visit (2 or 3 Conditions)
Payable only if a 00311 has been logged in the past 6 months.
00306 - Directive Care
You can only bill this twice per calendar week (Sunday to Saturday). According to MSP, Directive Care is billable only when "visits rendered by a consultant in cases in which the responsibility for the case remains in the hands of the attending practitioner but for which a consultant is requested by the referring physician to give directive care in hospital during the acute phase." Essentially this means that you bill 00306 instead of 00308’s when you’re not the MRP for the patient. If you need to see the patient more than twice in the week you can bill a 00308 or other codes as appropriate, but you’ll need to include an explanation of the necessity in the notes field.
00308 Subsequent Hospital Visit
You can bill this code multiple times in a day if required, but you'll need to provide an explanation in the notes as to why the patient needed to be seen more than the initial visit. After 30 days you can only bill this twice per week, unless you provide an explanation in the notes why the patient required the additional visits.
00305 Emergency Visit
These claims require a start & end time (our app will ask you to provide these). You cannot bill a Call Out or Continuing Care premium (see below for more on these fees) for these claims.
Call Out & Continuing Care
You get paid a premium on top of your consultations/procedure fees anytime you're specially called out to render services after 6:00pm (weekdays) or on Weekends. You don't have to be at home when you're called, just not in the hospital.
This doesn't apply if you're scheduled for weekend or evening service as part of your hospital coverage. So if you're working on the weekend, and saw patients you can't bill these. However, if you went home and were on call that evening and had to go back you can.
Log these premiums by toggling the Call Out and After Hours (This is the same as Continuing Care) buttons on your app. It'll then ask you for the Call, Start & End times for your claim. Enter these and we'll determine which code(s) need to be billed and we'll add that amount to the base fee for your consultation. So the app will show you the base amount for your consult, plus the premiums.
For the first patient you see when called out, toggle both Call Out and the After Hours switches. If you see any subsequent patients while at the hospital on that call, toggle just the After Hours switch and you'll get paid for each 30 minute interval you spend with each subsequent patient. If you saw patients for less than 15 minutes each, add up the total time and log that against the last patient you saw. Ex: If you saw 3 subsequent patients after the first call for 10 minutes each, toggle the After Hours button for the last patient and log a 30 minute interval and indicate in the notes you saw 3 patients for 10 minutes each).
Here's some other fees that are commonly billed by other GIM specialists.
10001 - Telephone Call Specialist Advice
You can log this when you are called for a consultation/advice on a patient over the phone. You can't log this when you initiate the call nor can you add Call Out or Continuing Care premiums to the claim. This is not payable for booking an appointment, arranging a consultation or procedure, lab results, etc. Only for discussion about the care of the patient. The call/conversion should be noted in the patient's chart (auditing purposes).
78717 Specialist Discharge Care Plan for Complex Patients
Billed for patients who require community support upon discharge and are otherwise at risk of readmission. A detailed care plan must be created for the patient. Patient must have been admitted for 5 days or longer, not application for elective procedures, care plan must be included in the patient's medical record. You must be the MRP for this patient.
78720 Specialist Advance Care Planning Discussion Extra
You can bill this if you have a discussion with the patient and/or their family about future care of a patient as their health deteriorates. A care plan template must be filled out with the consultation:
00314 Internal Medicine Prolonged Visit for Counselling
MSP's definition: "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." This is payable 4 times per year per patient.
10003 Specialist Telephone Patient Management Follow-up
You can bill this if you have a phone call with the patient to discuss their care or condition. You have to have seen the patient previously in the past 18 months and you cannot bill for this if you billed for other claims on this patient for the same day.
Here's some links to various documents that go into greater detail about billing for these claims. We also have a billing code lookup on our site that you can use to quickly find out the rules around a specific billing code.
MSP Billing Code Lookup
Internal Medicine Fee Guide
Call Out & Continuing Care Fee Guide
Special Service Committee Guide