78717 - Specialist discharge care plan for complex patient

General Info

Billing Amount: $75.00

Description

This fee is intended to support clinical coordination leading to effective discharge and community based management of complicated patients. It is to be billed for patients who require community support upon discharge and are otherwise at risk of readmission.

Notes:

This fee is payable for the communication and clinical oversight of a patient discharge care plan for complex patients.

i) Payable to the Specialist Physician who is the MRP for the majority of the patient’s in-hospital care and writes the care plan.
ii) Discharge Care Plan must be shared with patient at time of discharge and primary care provider must be notified of admission by phone, fax, or electronic means within 24 hours of discharge of patient, and a record of the communication included in the discharge summary in the patient’s chart.
iii) Patient must be an admitted in-patient with length of stay greater than 4 days. iv) Patientmusthaveoneofthefollowing:

A. Multiple medical needs or complex co-morbidities (two or more distinct but potentially interacting problems) where care needs to be coordinated over a period of time between several health disciplines. Please use the ICD9 code for one of the major disorders when submitting your billing.

B. Diagnosis of malignancy (excluding non-melanoma skin cancer). Please use the ICD9 code for one of the major disorders when submitting your billing.

C. One morbidity plus a minimum of one of the following non-medical conditions: poor socioeconomic status, unstable home environment, dependency on family/caregiver for daily living tasks, accessibility/mobility issues, under care of MCFD Protection Services, received Tertiary or Acute level of care related to psychiatric condition within the previous 6 Months, frail elderly, >75 years old, BMI > 35 or high readmission rate. Please use the following code X-X-X when submitting your billing.

v) Payable once per patient per discharge from hospital.
vi) Claim on the day of discharge.

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