MSP Billing Guide for Neurology

This is the second of our series of condensed guides on MSP billing. Today we cover billing for neurology practitioners.

Consultations

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 complex consult and a new condition arises you should bill 00410.

00410 – 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.

00411 - Repeat or limited consultation
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.

Continuing Care by Consultant

00406 - 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 00406 instead of 00408’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 00408 or other codes as appropriate, but you’ll need to include an explanation of the necessity in the notes field.

00408 - 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. 
 
00405 - Emergency visit when specially called
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.

Complex Care

G00450 Complex Care - Extended Consultation (per 15 minutes)
After your initial 45 minute consult, you can bill this for each additional 15 minutes spent with the patient. There is a maximum of 1.5 hours per patient during a single encounter.

G00457 Complex Care – Extended Visit (per 15 minutes)
After your initial 15 minute visit you can bill this for each subsequent 15 minutes to a maximum of 30 minutes per patient in one sitting.

G00460 Transfer of Care from Paediatrics
Extended Consultation: For paediatric patients 16 years of age and older. Primary responsibility for the neurologic management of a patient transferring from paediatric to adult care, and includes review of ALL necessary data, including birth and developmental assessments. Payable once per patient in that patient's lifetime. Not paid with to 00410, 00411, 00441, 40441, 00470, 00471 G00450 or G00457.

ACVS - Acute Cerebral Vascular Syndrome (Stroke & TIA)
Must use stroke codes (431, 433, 434, 435) as the diagnosis. 
With any ACVS billing, please include the patient’s NIHSS 2-digit code in the “Notes Field” of your claims.

00441 - Face to face ACVS Consultation
You can bill this for patients seen within 4.5 hours of onset of symptoms for stroke/TIA or within 72 hours of onset of symptoms for relapse prevention (P00444). After 30 minutes spent with the patient you can bill the 00442 for the remainder time spent.

00442 - Face to face follow-up neurological clinical monitoring and treatment for persisting ACVS (without tPA)
Bill for each 30 minutes after the initial 30 minute ACVS Consultation (00441).

00443 - Face to face follow-up neurological clinical monitoring and treatment for persisting ACVS (with tPA) 
Bill for each 30 minutes after the initial 30 minute ACVS Consultation (00441). Maximum of 3 hours per patient in a day. If time exceeds that, a note record is required to explain why.

00444 - Face to face follow-up ACVS relapse intervention
Bill for each 30 minutes after the initial 30 minute ACVS Consultation (00441). Maximum of 2 hours per patient in a day. If time exceeds that, a note record is required to explain why.

MS Patients

P00485 - Face to face assessment for acute deterioration in status of an MS patient
1st full half hour. Must have been seen previously by any Neurologist for diagnostic code 340. Payable every 42 days to a maximum of twice per patient per year.  After the initial 30 minutes, bill P00486 for each additional 30 minutes.

P00486 - Face to face assessment for acute deterioration in status of an MS patient extra
Bill for each 30 minutes after the initial 30 minute assessment (P00485) to a maximum of 8 hours. 

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).