Conferencing on an urgent basis (within 2 hours of request for a telephone conference) with a specialist or GP with specialty training by telephone followed by the creation, documentation, and implementation of a clinical action plan for the care of patients with acute needs; i.e. requiring attention within the next 24 hours and communication of that plan to the patient or patient's representative
Payable to the GP who initiates a two-way telephone communication (including other forms of electronic verbal communication) with a specialist or GP with specialty training regarding the urgent assessment and management of a patient but without the responding physician seeing the patient.
A GP with specialty training is defined as a GP who:
a. Provides specialist services in a Health Authority setting and is acknowledged by the Health Authority as acting in a specialist capacity and providing specialist services;
b. Has not billed another GPSC fee item on the patient in the previous 18 months; Telephone advice must be related to the field in which the GP has received specialty training.
The intent of this initiative is to improve management of the patient with acute needs, and reduce unnecessary ER or hospital admissions/transfers.
This fee is billable when the severity of the patient’s condition justifies urgent conference with a specialist or GP with specialty training, for the development and implementation of a care plan within the next 24 hours to keep the patient stable in their current environment.
This fee is not restricted by diagnosis or location of the patient, but by the urgency of the need for care.
Conversation must take place within two hours of the GP’s request and must be physician to physician. Not payable for written communication (i.e. fax, letter, e-mail).
a. Discussion with the specialist of pertinent family/patient history, history of presenting complaint, and discussion of the patient's condition and management after reviewing laboratory and other data where indicated.
b. Developing, documenting and implementing a plan to manage the patient safely in their care setting.
c. Communication of the plan to the patient or the patient’s representative.
v) The care plan must be recorded in the patients chart and include the following information:
a. Patient’s Name.
b. Date of Service.
d. Reason for need of Clinical Action Plan.
e. Name of specialist/GP with specialty training & their role in provision of care.
f. Elements of the Clinical Action Plan determined.
g. Patient risks based on assessment of appropriate domains (list of relevant co-morbidities and safety risks).
h. What referral will be made, what follow-up has been arranged (including timelines), as well as advanced planning information if appropriate.
i. Start times of service.
vi) Not payable to the same patient on the same date of service as any other Patient Conference (fee items G14015, G14016, G14017), complex care, mental health or palliative care planning (G14033, G14043, G14063) or telephone fees.
vii) Not payable to physicians who are employed by, or who are under a contract to a facility, who would otherwise have provided the service as a requirement of their employment or contract with the facility; or physicians working under salary, service contract or sessional arrangement.
viii) Include start time in time fields when submitting claim.
ix) Not payable for situations where the primary purpose of the call is to:
a. book an appointment
b. arrange for transfer of care that occurs within 24 hours
c. arrange for an expedited consultation or procedure within 24 hours
d. arrange for laboratory or diagnostic investigations
e. inform the other physician of results of diagnostic investigations
f. arrange a hospital bed for the patient.
g. obtain non-urgent advice for patient management (i.e. not requiredwithin the next 24 hours).
x) Limited to one claim per patient per physician per day.
xi) Out-of-Office Hours Premiums and Rural Retention Premiums may not be claimed in addition.
xii) Maximum of 6 (six) services per patient, per practitioner per calendar year.
xiii) Visit payable on same date of service if medically required and does not take place concurrently with the clinical action plan.