General practitioners have hundreds of codes to bill depending on which services they provide – but in many circumstances, they're not capturing the most they could be and are missing out on potential earnings.
Our team is continuously analyzing our data to find opportunities for doctors to maximize their billing. One of the way they do this is by identifying specific codes that most physicians don't bill, but should.
Today's example is G14066 – the code for a Personal Health Risk Assessment.
Who can bill it
Any GP who performs a personal health risk assessment with a patient who is:
• a smoker
• physically inactive
• an unhealthy eater
Which patients are eligible
Eligible patients must be living at home or in assisted living. Patients in acute and long term care facilities are not eligible.
This fee code can only be billed on a patient once a year.
The GP needs to create a personalized plan that outlines actions for the patient to take. You'll also need to document the discussion with the patient, and the plan of action, in the patient's chart.
The plan should be tailored to the patient's age and sex. As well, it needs to align with the Lifetime Prevention Schedule and GPAC Obesity and Cardiovascular Disease Prevention Guidelines.
A face to face visit is required with the patient or patient’s medical representative. The G14066 must also be billed with the age-related visit fee.
How to bill it
Submit 14066 with one of the following diagnostic codes: Smoking (786), Unhealthy Eating (783), Physical Inactivity (785), or Medical Obesity (783).
Bill the visit (office or home) or CPx fee to indicate a face-to-face interaction with the patient (or patient's representative). This code must be billed for the same date of service.
Other rules and restrictions for billing this code are as follows:
- G14016 or G14077 are payable on the same day for the same patient if all criteria are met.
- G14015, G14017, G14033, G14043, G14063, G14076 and G14079 are not payable on the same day for the same patient.
- A physician can bill this for a maximum of 100 patients per year.
- Not payable once G14063 has been billed and paid as patient has been changed from active management of chronic disease to palliative management.
- Physicians who work at a facility and/or are paid by salary, service contract or sessional arrangement and would be required to provide this service as part of their duties cannot bill this code.