MSP Billing Tips – Neurology

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 Pediatrics
Extended Consultation: For pediatric patients 16 years of age and older. Primary responsibility for the neurologic management of a patient transferring from pediatric 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).


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MSP Billing Tips – General Internal Medicine (GIM)

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 arrises during their stay. If you've already billed a complex consult and a new condition arrises you should bill 00310, unless more than 1 new condition arrises and you 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.

Continuing Care

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).

Other Fees

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: http://www.sscbc.ca/sites/default/files/ACP_Template.pdf
                       
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.                     

Helpful Resources

Here's some links to various documents that go into great 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
MSP Pre-amble


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How do I move a patient into a patient group?

Related question: Once I've created a patient in "All Patients" how do I move that patient to a "Patient Group"?

On the mobile app, you can add patients to groups by swiping left over the patient's name – this will give you the option to add that patient to one of your existing Groups.

On the web, go to Groups in the search bar on the top-left & you can search your list of patients and add them to the group from there.


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I have recently become incorporated, how do I update my banking?

Related question: How do I apply for an Incorporated payee number?

Have you applied for an Incorporated MSP payee number as well? If not, the reason we suggest this is that without an actual INC payee number the funds will still be paid in your non-INC name. While the payments will go to your corporate account, they will not be in your Incorporated name.

Please email a copy of your Corporate Medical Permit from the College to caitlyn@dr-bill.ca as MSP will require this and ask to apply for an Incorporated Payee Number.


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How do I select the location of my patient encounter?

Related question: What are the location codes to designate where patient encounters take place?

When logging a claim on the web or in the app, select the corresponding location code from the drop down menu. See the table below for a description of the location codes:

CodeDescriptorDefinition
CResidential Care / Assisted Living ResidenceService is provided to a patient in a licensed residential care facility or registered assisted (Note: Excludes small “group homes” where no professional health care support/care is available and includes extended care facility within a hospital).
DDiagnostic FacilityService is provided in a facility that primarily/exclusively provides diagnostic testing and has been granted a MSC Certificate of Approval (Note: Excludes diagnostic tests provided in a practitioner’s office. Also excludes diagnostic services provided in/by hospital and/or D&T centre facilities).
EHospital – Emergency Room (Unscheduled Patient)Service is provided in a hospital emergency department for a patient who presents for emergency or urgent treatment (Note: Excludes hospital outpatients who receive services on a scheduled basis within an emergency department – see Hospital Outpatient).
IHospital – InpatientService is provided for a patient who is an inpatient of a hospital (Note: Excludes patients located within a designated “extended care unit” within a hospital – see Residential Care/Assisted Living Residence).
PHospital – OutpatientService is provided in outpatient and/or ambulatory clinics where outpatients receive scheduled services including emergency department, or any other hospital setting where outpatients receive services (Note: Excludes day care surgical patients).
RPatient's Private HomeService is provided in a patient’s own home (Note: Includes service provided in “group homes” where on-site nursing or other health professional support care is not provided, but excludes assisted living residences and other residential facilities – see Residential Care/Assisted Living Residence).
ZOther (e.g. accident site or ambulance)Service is provided in any other location such as a temporary community or school clinic, ambulance, accident site etc.
GHospital – Day Care (Surgery)Service is provided within a hospital to a patient who is a day care surgery patient (Note: Includes all patients who are in hospital on a day care basis primarily to receive a “procedure”. Excludes scheduled services – see Hospital – Outpatient).
FPrivate Medical / Surgical FacilityService is provided within a private medical/surgical facility accredited by the College of Physicians and Surgeons of BC.
APractitioner's Office – In CommunityService is provided in a practitioner’s office (Note: Excludes practitioner’s offices that are located within a publicly administered health facility – see Practitioner’s Office – In Publicly Administered Facility. Includes services provided by a physician, chiropractor, dentist, optometrist, podiatrist, physiotherapist, and massage therapist).
MMental Health CentreService is provided in a publicly administered mental health centre to an outpatient (Note: Excludes mental health facilities that are primarily residential in nature – see Residential Care/Assisted Living. Includes CRESST Facilities).
TPractitioner's Office – In Publicly Administered FacilityService is provided in a practitioner’s office located within a publicly administered health facility (e.g., Hospital, Primary Care Centre/Clinic, D&T Centre, etc…).

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GPSC Incentives

Maternity Network Incentive

The Maternity Network Initiative helps FPs share the responsibilities of providing continuous obstetrical coverage and full-scope maternity care.

Billing Guide

Registration Form

Assigned In-Patient Incentive

The Assigned In-patient Network payment is for FPs who provide in-patient
care services for their own and colleagues’ patients (assigned).

Billing Guide

Registration Form

 

Unassigned In-Patient Incentive

The Unassigned In-patient Network payment is a lump sum incentive for hospitals with a community GP run unassigned inpatient care model.

Billing Guide

Registration Form

 

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How do I add a claim?

If you haven't downloaded the app already, click here for iOS and here for Android
Don't have any patients added? Click here to find out how to add one.

 

From a patient's card, tap the 'New Claim' button to create a new claim.
You will then see this view:

Dr Bill - How to add a claim

 When selecting a Billing Item you will see this view – search by number or description and tap the appropriate billing code.

Dr Bill - Choose a billing code

When you hit Diagnosis you will see this view – search ICD9s and select up to three diagnoses.

Dr Bill - Select up to 3 ICD9s

From the 'Add Claim' view, hit Save and you're done!


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How do I add a patient?

If you haven't downloaded the app already, click here for iOS and here for Android.

Add a patient on Dr. Bill

Use Dr. Bill's Label Snap

To quickly add a patient, simply snap a photo of each patient label.

Dr. Bill will capture all the patient information. You can also add a patient manually.

Once created, you can log claims for a patient immediately.

 
 
Dr Bill - Adding a patient

 On an individual patient card, you can see their information and claim history. From here you can edit patients and add new claims.

Dr Bill - Adding a patient - Edit patient

 

Hit 'New Claim' at the bottom to add a claim.


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I have completed my paperwork, how long before I can start billing?

You can start logging your claims immediately!

Your claims are held on our secure server until you are officially connected to Dr. Bill. Once connected, your claims are submitted on the next MSP cut off date.

Thereafter, your claims are submitted nightly. MSP takes approximately 5 business days to process applications and we will notify you as soon as you become connected.


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What is a MSP billing number versus a MSP payee number?

When you begin billing in BC you are provided with a MSP practitioner number/billing number. This number stays with you forever and does not change. This is the number that colleagues will use as your referring practitioner number.

Underneath your practitioner number you can have several Payee Numbers. A payee number simply tells MSP where to send payment for claims submitted under that number. If you are new to billing your practitioner number and payee number is likely the same number.

You begin to add new billing numbers as you incorporate or begin billing in multiple locations at once. A single payee number can only be used to bill with a single billing service/EMR at a time.


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How do I bill for a baby?

The best way to bill for a baby is to bill using mom's PHN. It often takes some time for the baby to become enrolled in MSP so we find claims are paid quicker by billing under mom.

To do this you will create a patient using baby's name, mom's PHN, and mom's date of birth. Within the claim creation view you will see a check box titled Bill Child. Please select this and provide the baby's date of birth next to it. This will correctly bill for baby under mom's PHN. 


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I have a Syrian Refugee, how do I get paid?

Claims for Syrian Refugees are payable through the Interim Federal Health program. Please provide us with the location you cared for the patient and the UCI number that is provided to the patient. We charge 25$ per patient for this process as we need to register you with Blue Cross as a provider before we can submit the claim form.


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I have a patient that does not have insurance, is there a way I can get paid?

If your patient does not have insurance we offer a private invoicing option. If you are able to provide an address we will invoice the patient on your behalf using BCMA rates. We charge 25% for anything recovered. Multiple invoices are sent on your behalf as required.


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How can I add out-of-province information for a patient?

When you select to edit a patient there is a drop down menu to select the Province of Insurance. If you select a Province other than BC further boxes will populate for you to enter the patient's address. This is required for Out-of-Province billing. 


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I work in a rural area and qualify to have a rural premium added to my billings. How do I do this?

There are two options for this feature. If you are only occasionally working in an eligible rural area you can manually add the rural premium to each claim by selecting the location in the Rural Location drop down menu.

Alternatively, if you permanently or frequently work in a rural location you can provide us with that information and we can set this in your profile to automatically apply to all of your claims or a set range of claims depending on the details you provide. You will see these rural premiums as an adjustment on your remittance payment information.


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Why do I have a large gap between my billed and paid claims?

It is important to keep in mind that due to the cut off process with MSP there are often 4 weeks of billings that are pending processing from the first cut off of the month to the final pay period of the month. This will create a large gap between your billed and paid claims depending on the volume that you bill during those 4 weeks.


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