10004 - Spec multidisciplinary conferencing for complex pt

General Info

Billing Amount: $46.23 per 15 minutes

This Item requires times


A scheduled session/meeting to discuss and plan medical management of patients with serious and complex problems under circumstances where the patient is too complex for the specialists to deal with on his/her own. Payable only when coordination of care is required via a collaborative conference with at least two of the following: other specialists, GPs, allied health providers and/or coordinators of the patient’s care.


i) Includes scheduled face to face, telephone or video technology communication regarding assessment, clinical coordination and management of a complex patient.
ii) Patient must have one of the following:

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.

iii) All specialists involved in the conference may each independently bill for this fee.
iv) Not payable to the same patient on the same date of service as 00545, P00645, G33445, G10001, G10002, G10003, G10005, G10006, G78717
vi)The results of the case conference must be recorded in the patient's chart along with the start and end times of the conference, as well as the names and job titles of the other participants at the meeting.
viii) Maximum of 4 units may be claimed per patient per day.
ix) Not to exceed a maximum of 16 units per patient per year.
x) If multiple patients are discussed, the billings shall be for consecutive, non-overlapping time periods and services are to be claimed under the PHN of each patient for the specific time period.

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