Confused by MSP’s billing codes? You’re not alone! Part of demystifying the billing process is being able to understand the components of different fee codes – what they mean, who they refer to, and when to use them. When you’re able to understand at a glance which codes you can use in certain situations – and which you can’t – you’ll be able to keep on top of MSP updates, bill more efficiently, and decrease the number of billing errors you make.
Not all MSP billing codes use a prefix. The majority of codes that you’ll bill as a surgeon will appear in the Payment Schedule (check the lookup tool for a faster search) as a 5 digit numerical code, and prefixes won’t show. However, some codes have special rules or additional information associated with them, and this is when MSP will use a prefix to flag the code as having certain rules. If you’re wondering what prefixes mean, here are the basics:
Fee codes beginning with ‘B’ let you know that the fee contains services already included in the visit fee. For example, minor diagnostic or therapeutic procedures like injecting intramuscular medicines (B00010) have a fee value that is less than the office visit – so if this is the only reason you need to see a patient, this code is all you will be able to bill. However, if you have an assessment or visit with a patient unrelated to the minor procedure you perform, you can claim either the procedure or the visit – but not both. In these cases, it’s better to claim the larger fee item if you want to make the most of your claim.
MSP uses the C prefix to indicate times when you are not required to note the need for a certified surgeon’s assistance. In most surgical billing codes (like fee code 70019 – Certified Surgical Assistant), you need to tell MSP in the notes why a certified general surgeon was required if you want to be able to bill for their time. However, if you’re billing a code like C56666 (Meniscal Allograft Transplant) MSP already has an understanding of the complexity of the procedure and why a certified surgeon is needed. In this case, you can leave the note out.
Fee items that originate from the Joint Clinical Committees and get transferred to the MSC Payment Schedule will be indicated with a G prefix. The Joint Clinical Committees are responsible for improving physician services and patient care in BC. These fee codes are usually add ons, modifiers, or updates to existing fee codes, sometimes intended to address labour market shortages for doctors and increase fees in certain specializations.
For example, fee code G04708 (Prolonged Laparoscopic Surgery) was introduced as part of a labour market initiative in 2011 to give doctors an additional $70 (adjusted for inflation) for laparoscopic surgeries that go beyond two hours.
Codes that begin with the letter H can be billed normally through the claims payment system, but are actually funded through the medical practitioner’s available amount. As of now, these fee codes are restricted to family physicians who are part of inpatient, outpatient, or maternity care networks.
Fee codes beginning with ‘P’ indicate fee items that have been approved on a provisional basis, and are still awaiting further review. You will see many of these P codes combined with the ‘G’ prefix (for example, PG04719 – Gynecology surgical surcharge for patients 75 years and older) since the Joint Clinical Committee codes are likely to be newer and less established in the Payment Schedule. You can bill for these fee codes the same way you normally would, keeping in mind that they may be changed or updated in the future.
Codes that begin with ‘S’ let MSP know that a surgical assistant’s fee is not payable for the item. This is mainly used for smaller surgeries, biopsies, or diagnostic procedures such as S00785 (Endometrial biopsy) or S00807 (Diagnostic Hysteroscopy), but can include any surgery that MSP deems ineligible for an assistant’s fee.
There are some fee codes that have been approved on a temporary basis and are awaiting further information. These will be indicated with prefix ‘T’ while they are temporary, and may or may not be added to the Payment Schedule without the prefix at a later date. You can bill these fee codes as normal, as long as they exist in the most up to date payment schedule.
Prefixes beginning with ‘V’ are codes exempt from the post-operative general preamble rules. The preamble states that follow-up services and visits following a surgery cannot be billed within the patient’s first 14 days in hospital, since the billing code for the surgical procedure already pays you for them. However, there are some fee codes where these rules do not apply. For example, you can bill for V07112 (ligation of 2 or more perforators) within this period and be paid over and above your usual surgical amount – so it’s a good idea to keep an eye out for these ‘V’ codes so you’re not leaving money on the table for the services you perform.
Fee codes that begin with Y let you know that you can bill an office or hospital visit on the same day as the procedure fee. Since they are commonly used for ‘same day’ or diagnostic procedures like SY00750 (lumbar puncture in a patient 13 years of age and over), they are often combined with ‘S’ codes, which indicate that assistant’s fees will not be payable.
If you’re a surgeon operating under MSP’s fee for service model, understanding the fee code prefixes can help you easily identify the right codes to use, keep on top of new and updated codes, and make the most of your time. Happy billing!
This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.
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