Creation of a coordinated clinical action plan for the care of community-based patients with more complex needs. Payable only when coordination of care and two-way collaborative conferencing with other health care providers is required (e.g. specialists, psychologists or counsellors, long-term care case managers, home care or specialty care nurses, physiotherapists, occupational therapists, social workers, specialists in medicine or psychiatry) as well as with the patient and possibly family members (as required due to the severity of the patients condition) - per 15 minutes or greater portion thereof
Refer to Table 1 (below) for eligible patient populations.
Fee is billable for conferences that occur as a result of care provided in the following community locations for patients who are resident in the community:
•Community GP Office
•Community placement agency
•Disease clinic (DEC, arthritis, CHF, Asthma, Cancer or other palliative diagnoses, etc.
a. The interviewing of patient and family members as indicated and the conferencing with other health care providers as described above - this does not require face-to-face interaction in all cases and;
b. As appropriate, interviewing of, and conferencing with patients, family members, and other community health care providers; organizing and reviewing appropriate laboratory and imaging investigations, administration of other types of testing as clinically indicated (e.g.: Beck Depression Inventory, MMSE, etc); provision of degrees of intervention or No CPR documentation; and
c. The communication of that plan to patient, other health care providers, and family members or others involved in the provision of care, as appropriate; and
d. The care plan must be recorded in the chart and include the following information:
1., Patient’s Name
2. Date of Service
a. V15 (Frail Elderly)
b. V58 (Palliative/End of Life Care)
c. Mental Illness (enter ICD-9 code of qualifying illness)
d. Patients of any age with multiple medical needs or complex co-morbidity (enter ICD-9 code for one of the major disorders)
4. Reason for need of Clinical Action Plan
5. Health care providers with whom you conferred & their role in provision of care
6. Cinical Plan determined, including tests ordered and/or administered.
7. Patient risks based on assessment of appropriate domains (list of co-morbidities and safety risks)
8. List of priority interventions that reflect patient goals for treatment
9. What referrals will be made, what follow-up has been arranged (including timelines and contact information), as well as advanced planning information
10. Start and stop times of service.
iv) Maximum payable per patient is 90 minutes (6 units) per calendar year. Maximum payable on any one day is 30 minutes (2 units).
v) Claim must state start and end times of service.
vi) Not payable to the same patient on the same date of service as the Facility Patient Conference Fee (fee item G14015), Acute Care Discharge Planning Conference Fee (G14017), GP Attachment Conference Fee (G14077) or GP Attachment Complex Care Management Fee (G14075).
vii) Not payable to physicians who are employed by, or who are under contract to a facility, who would otherwise have attended the conference as a requirement of their employment or contract with the facility; or physicians working under salary, service contract or sessional arrangements.
viii) Visit payable in addition if medically required and does not take place concurrently with clinical action plan.
Please reference the billing pre-amble for these relevant interpretations of this billing code:See Pre-Amble Notes