General practice 14043 - Gp mental health planning fee

General Info

Billing Amount: $100.00


This fee is payable upon the development and documentation of a patient’s Mental Health Plan for patients resident in the community (home or assisted living, excluding care facilities) with a confirmed Axis I diagnosis of sufficient severity and acuity to cause interference in activities of daily living and warrant the development of a management plan.
This fee requires the GP to conduct a comprehensive review of the patient’s chart/history, assessment of the patient’s current psychosocial symptoms/issues by means of psychiatric history, mental status examination, and use of appropriate validated assessment tools, with confirmation of diagnosis through DSM IV diagnostic criteria. It requires a face-to-face visit with the patient and/or the patient’s medical representative.
From these activities (review, assessment, planning and documentation), a Mental Health Plan for that patient will be developed that documents in the patient’s chart, the following:
1. That there has been a detailed review of the patient’s chart/history and current therapies;
2. The patient’s mental health status and provisional diagnosis by means of psychiatric history and mental state examination;
3. The use of and results of validated assessment tools. The GPSC strongly recommends that these evaluative tools, as clinically indicated, be kept in the patient’s chart for immediate accessibility for subsequent review. Assessment tools such as the following are recommended, but other assessment tools that allow risk monitoring and progress of treatment are acceptable:
a) PHQ9, Beck Inventory, Ham-D for depression;
b) MMSE for cognitive impairment;
c) MDQ for bipolar illness;
d) GAD-7 for anxiety;
e) Suicide Risk Assessment;
f) Audit (Alcohol Use Disorders Identification Test) for Alcohol Misuse;
4. DSM-IV Axis I confirmatory diagnostic criteria;
5. A summary of the condition and a specific plan for that patient’s care;
6. An outline of expected outcomes;
7. Outlined linkages with other health care professionals (Including Community Mental Health Resources and Psychiatrists, as indicated and/or available) who will be involved in the patient’s care, and their expected roles;
8. An appropriate time frame for re-evaluation of the Mental Health Plan;
9. That the developed plan has been communicated verbally or in writing to the patient and/or the patient’s Medical Representative, and to other health professionals as indicated. The patient and/or their representative/family should leave the planning process knowing there is a plan for their care and what that plan is.
Following the successful billing of the Mental Health Planning fee, the GP will have access to 4 additional counselling equivalent mental health management fees per calendar year once the 4 MSP counselling fees have been billed.

Patient Eligibility:
• Eligible patients are community based, living in their home or assisted living. Facility based patients are not eligible.
i) Requires documentation of the patient’s mental health status and diagnosis by means of psychiatric history, mental state examination, and confirmatory DSM IV diagnostic criteria. Confirmation of Axis I Diagnosis is required for patients eligible for the GP Mental Health Planning Fee. Not intended for patients with self limiting or transient mental health symptoms (e.g.: Brief situational adjustment reaction, normal grief, life transitions) for whom a plan for longer term mental health care is not necessary.
ii) Payable once per calendar year per patient.
iii) Payable in addition to a visit fee billed same day.
iv) Minimum required time 30 minutes in addition to visit time same day.
v) G14016, Community conferencing fee payable on same day for same patient, if all criteria met.
vi) Not payable on the same day as G14044, G14045, G14046, G14047, G14048 (GP Mental Health Management Fees).
vii) G14079 GP telephone /e-mail management fee is not payable on the same day.
viii) Not intended as a routine annual fee if the patient does not require on-going Mental Health Plan review and revision.
ix) G14015, Facility Patient Conferencing Fee, not payable on same day for same patient as facility patients are not eligible.
x) Not payable to physicians who are employed by or who are under contract to a facility and whose duties would otherwise include provision of this care.
xi) Not payable to physicians working under salary, service contract or sessional arrangements whose duties would otherwise include provision of this care.
Successful billing of the mental health planning fee (G14043) allows access to 5 Telephone/e-mail follow-up fees (G14079) per calendar year.over the following 18 months.

The following list of diagnosis and acceptable (ICD9) codes are applicable for the Mental Health Planning and Management Fee, fee items G14043, G14044 – G14048, and G14079:
Adjustment Disorders: (309)
Adjustment Disorder with Anxiety (309)
Adjustment Disorder with Depressed Mood (309)
Adjustment Disorder with Disturbance of Conduct (309)
Adjustment Disorder with Mixed Anxiety and Depressed Mood (309)
Adjustment Disorder with Mixed Disturbance of Conduct & Mood (309) Adjustment Disorder NOS (309)Anxiety Disorders: (300)
Acute Stress Disorder (308)
Agoraphobia (300)
Anxiety Disorder Due to a Medical Condition (300)
Anxiety Disorder NOS (300)
Generalized Anxiety disorder (50B), (300)
Obsessive-Compulsive Disorder (300)
Panic Attack (300)
Post-Traumatic Stress Disorder 309
Social Phobia (300)
Specific Phobia (300)
Substance-Induced Anxiety disorder (300)
Attention Deficit Disorders:
Attention Deficit disorder (314)
Cognitive Disorders: Amnestic Disorder (294)
Delirium (293)
Dementia (290),(331),(331.0),(331.2)
Dissociative Disorders:
Depersonalization Disorder (300)
Dissociative Amnesia (300)
Dissociative Fugue (300)
Dissociative Identity Disorder (300)
Dissociative Disorder NOS (300)
Eating Disorders:
Anorexia Nervosa (307.1), (783.0), (307)
Bulimia (307)
Eating Disorder NOS (307)
Factitious Disorders: (300),(312)
Factitious Disorder; Physical & Psych Symptoms (300),(312)
Factitious Disorder; Predom Physical Symptoms (300),(312)
Factitious Disorder; Predominantly Psych Symptoms (300),(312)
Impulse Control Disorders: (312)
Impulse Control Disorder NOS (312)
Intermittent Explosive Disorder (312)
Schizophrenia and other Psychotic Disorders: (295),(296),(297),(298)
Paranoid Type (295),(297),(298)
Disorganized Type (295), (298)
Catatonic Type (295), (298)
Undifferentiated Type (295), (298)
Residual Type (295), (298)
Brief Psychotic Disorder (295), (298)
Delusional Disorder (295), (298)
Psychotic Disorder due to Medical Condition 293
Psychotic Disorder NOS (295), (298)
Schizoaffective Disorder (295), (298)
Schizophreniform Disorder (295), (298)
Substance-Induced Psychosis (295), (298)
Sexual and Gender Identity Disorder Paraphilias: (302)
Exhibitionism (302)
Fetishism (302)
Frotteurism (302)
Pedophlia (302)
Sexual Masochism (302)
Sexual Sadism (302)
Transvestic Fetishism (302)
Voyeurism (302)
Paraphilia NOS (302)
Sexual Dysfunction: (302)
Hypoactive Sexual Desire Disorder (302)
Female Orgasmic Disorder (302)
Male Orgasmic Disorder (302)
Premature Ejacualation (302)
Sexual Aversion Disorder (302)
Sexual Dysfunction due to a Medical Disorder (625)
Sexual Dysfunction due to a Substance (302)
Sexual Pain Disorders:
Dyspareunia (not due to a Medical Condition) (302)
Vaginismus (not due to a Medical Condition) (302)
Sleep Disorders:
Primary Insomnia (307)
Primary Hypersomnia (307)
Narcolepsy (347)
Breathing-Related Sleep Disorder (780.5)
Circadian Rhythm Sleep Disorder (307.4)
Insomnia Related to Another Mental Disorder (307.4)
Nightmare Disorder (Dream Anxiety Disorder) (307.4)
Sleep Disorder Due to a Medical Condition (780.5)
Sleep Disorder Related to another Medical Condition (780.5)
Sleepwalking Disorder (780.5)
Substance-Induced Sleep Disorder (780.5)
Somatoform Disorders: Somatization Disorder ( 300.8)
Conversion Disorder ( 300.1)
Pain Disorder ( 307.8)
Hypochondriasis ( 300.7)
Body Dysmorphic Disorder ( 300.7)
Substance - Related Disorders: Substance-Induced Anxiety Disorder (303), (304), (305)
Substance-Induced Mood Disorder (303), (304), (305)
Substance-Induced Psychosis (292)
Substance-Induced Sleep Disorder (303), (304), (305)
Alcohol Dependence Syndrome (303)
Drug Dependence Syndrome (304)
Drug Abuse, Non-Dependent (305)

In order to encourage non-face-to-face communication with patients covered by some of the GPSC incentives, the initial four separate telephone/e-mail follow up fees have been simplified into a single code that will still apply to the planning incentives (Complex Care G14033, Mental Health G14043, Palliative Care G14063 & COPD G14053 which requires a COPD Action Plan). Patients covered by one or more of these incentives are eligible for five telephone/e-mail services over the 18 months following the billing of the qualifying incentive(s).