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Get Smart! Office Practice Management
Billing Basics: Office PracticeMay 28, 2015
Dr Wendy Tink, BSc, CCFP, FCFP
- 1 -Practice Management Billing . Department of Family Medicine . Fee codes May 28, 2015 . Dr Wendy Tink
2 -Practice Management Billing . Department
of Family Medicine . Fee codes May 28 2015 . Dr Wendy Tink
3
Become a skilled clinician ….
… and
PRACTICE BILLING … before it really matters!
Practice Management Billing . Department of Family Medicine . Fee codes May 28
2015 . Dr Wendy Tink
Income streams
+
++
ContractsLeadership
Shared CareARP CUPS
Family Care Clinics
Uninsured Services (3rd Party)
Companies PayPatients Pay
Fee for Service
(FFS)Public Funds
PCN
Industry
WCB+
- 4 -
Practice Management Billing . Department of Family Medicine . Fee codes May 28
2015 . Dr Wendy Tink
Get Smart! Agenda
Part 1 Large group presentation (HELPFUL)• How to think, codes, tools to use, practice
Part 2 Small group practice (FUN) • Patient day sheet, tools • Fill in dx codes and fee codes• Patient totals and day total
Part 3 Present results (PRIZES)• Discussion/pearls
Part 4 Uninsured Services/3rd Party (MAYBE)
Part 5 Summary - 5 -
Practice Management Billing . Department of Family Medicine . Fee codes May 28,
2015 . Dr Wendy Tink
•
FFS: OFFICE VISIT CODES
Office Visit fee codes
Counselling
pain 03.05O
cancer 03.05I
psych 08.19G
- 6 -
Complete Exam03.04A
Limited Exam03.03A
Pick one stream
Practice Management Billing . Department of Family Medicine . Fee codes May 28
2015 . Dr Wendy Tink
•
Visit fee codes + pregnancy
Counselling
pain cancer
psych
St
- 7 -
Complete03.04
Limited03.03
03.04B03
03.03A 03.03B
Pick one stream
03.04A 03.04B
If pregnant change the letter A to B
Practice Management Billing . Department of Family Medicine . Fee codes May 28, 2015 . Dr Wendy Tink
Fee codes: values April 1, 2015
- 8 -
Comprehensive
03.04A/B $101.93
03.04M (preop) $101.93
03.05H DLM * $83.40 * age 74.5
Limited
03.03A/B $36.64
Limited Consult
03.07A $64.87
Counselling
pain
cancer
psych
Pick one stream
Practice Management Billing . Department of Family Medicine . Fee codes May 28, 2015 . Dr Wendy Tink
Fee codes: dollar amounts
- 9 -
Comprehensive03.04A/B $101.93
03.04M preop $101.93
03.05H DLM $83.40
Up to 30 minPg22
Limited Visit03.03A/B $37.07
Limited Consult
03.07A $64.87
Up to 15 minPg22
Counselling
Pain* 03.05O $46.33
Palliative* 03.05I $50.66
Psych 08.19G $46.33
15 min units
Pg32,35
Pick one stream: choose wisely
Practice Management Billing . Department of Family Medicine . Fee codes May 28 2015 . Dr Wendy Tink
Fee codes: time modifiers direct/indirect
- 10 -
ComprehensiveAt 30 min add modifier
1 only $31.11
03.04A/B $101.9303.04A + cmxc 30
03.04M preop $101.9303.04M + cmxc30
03.05H DLM $83.40
03.05H + cmxv30 $31.11
Limited at 15 min + cmgp01*
$17.61+ cmgp each next 10 mins
(max 10)
03.03A/B $36.64
15 min 03.03A + cmgp01$54.68
25 min 03.03A + cmgp02$72.29
35 min 03.03A + cmgp03$89.90
Limited consult 03.07A $64.87
Counselling
Pain* 03.05O $46.33 x2 $92.66Palliative* 03.05I $50.66
Psych 08.19G $46.33
15 min units**Modify by
doubling** major portion
Pick one stream: longer visits add modifiers**
Practice Management Billing . Department of Family Medicine . Fee codes May 28 2015 . Dr Wendy Tink
Fee codes: relative value
- 11 -
Comprehensive+1 cmxc30
$31.11
Periodic exam 30 min
03.04A + cmxc30 $101.93 + $31.11
$133.04/30min
$66.52/15min
Limitedat 15min +cmgp $17.61
+cmgp each next 10 mins max 10
Visit 15 min
03.03A + cmgp01 $37.07 + $17.61
$54.68/15 min
Visit 25 min03.03A +cmgp02
$72.29
CounsellingPer 15 min
Pain* 03.05O $46.33
Palliative* 03.05I $50.66
Psych 08.19G $46.33
15 min
Double/major portion
* team
Pick one stream: best value
Practice Management Billing . Department of Family Medicine . Fee codes May 28, 2015 . Dr Wendy Tink
Fee codes: review
- 12 -
Comprehensive
First PNPeriodic exam
03.04A/Bdirect care
+ Time modifier at 30 min
direct / indirect
+1 cmxc30$31.11
Pg 21
Limited
Routine visit03.03A/B
direct care
+cmgp at 15 min and
+cmgp each next 10 mins max 10
direct / indirectcmgp each $17.61
Pg 20
CounsellingPer 15 min
Double at 1/2 int
Pain* 03.05O $46.33
Palliative* 03.05I $50.66
Psych 08.19G $46.33
direct care
Pick one stream: insert into memory!
Practice Management Billing . Department of Family Medicine . Fee codes May 28 2015 . Dr Wendy Tink
Add diagnostic codes to get paid complexity measure
• Diagnostic Codes
ICD 9
465 URTI 706 acne 724 back pain 250 diabetes 314 ADHD 428 heart failure V04.8 influenza immunization assessment V65 consultation, not sick V20.1 growth & development
- 13 -
Practice Management Billing . Department of Family Medicine . Fee codes May 28, 2015 . Dr Wendy Tink
Overview
Practice Management Billing . Department of Family Medicine . Fee codes May 28, 2015 . Dr Wendy Tink - 14 -
Comprehensive Visits
At 30 min add
CMXC30 = $31.11Direct/IndirectOne only
Limited Visits03.03A
At 15 min 03.03A +CMGP
01
>25 min 03.03A +CMGP02
>35 min 03.03A +CMGP 03
>45 min 03.03A +CMGP 04
$37.07
$54.68
$72.29
$89.90
$107.51
Palliative Chronic Pain Psychiatry
03.05I* $49.09
03.03O* $44.90
08.19G $44.90
*increase the number of units for the time modifiers
Visits Time Modifiers ProceduresPhone calls
Call back ltc ++ + +Complex Care
Plan +
Annual Complex Care Plan most responsible doc
Practice Management Billing . Department of Family Medicine . Fee codes May 28, 2015 . Dr Wendy Tink - 15 -
Group A
Hypertension 401
DM 250
COPD 496
Asthma 493
Heart Failure 428
Ischemic HD 413-414
Chr Renal Failure 585,586
Group B
Mental Health 290 - 319
Obesity 278
Addictions 303 – 304
Tobacco 305
Visits Time Modifiers
PhoneCall to ltc+ +
Complex Care Plan
pg23PhoneProcedures+ ++
03.04J$193.97
• 2 chronic diseases A/B• smart goals patient &doc• signed doc* &patient• once yearly• review / follow up
Fee Codes: Add procedures
Practice Management Billing . Department of Family Medicine . Fee codes May 28, 2015 . Dr Wendy Tink - 16 -
Visits Time Modifiers Procedures
Phone CallsHome, ltc
visits+ + +
M add visit ? add tray?
07.57A Initial Burn $37.07 + tray
98.03A I + D Abscess $28.23 + tray + v
98.12C Removal Seb. Cyst $47.12 + tray + v
13.59A IM / SQ Injection $9.88 + v
13.99BC Pap or gyne swab $27.80 + v
81.8 IUD Insertion $67.18 + tray + v
93.91A Joint Aspiration/ $36.71 + tray + vInjection (Hip)
M + add visit
80.83B Endometrial Bx $42.75
98.12A Excisional Bx, skin $41.25
98.81B Punch Bx $26.94
97.81 Needle or Bx Breast $44.28
ALWAYS CHECK GP BILLING RULES AMA pg 50 April 2015
Complex Care Plan +
Fee Codes: Remember phone calls
Practice Management Billing . Department of Family Medicine . Fee codes May 28,2015 . Dr Wendy Tink - 17 -
Visits Time Modifiers Procedures
Called away Home visits
NH, ER, OB, Hosp+ + +
INR ( pt advise coumadin) 03.01N $16.99 Twice MonthlyPhysician to Physician * phone consult
03.01LG (H, I) $32.43/42.57/50.23
Physician to other Pg 25
03.01LM Ob outpatient worker $17.71/26.16/30.8703.01B Mental health worker $16.99/26.50/30.92
03.01NG Allied health - ltc, hosp+ $16.99/20.28/23.9403.01NM Pharmacist $15.1203.05JR Patient $15.12
Complex Care Plan
+
Phone Stuff
Fee codes: Out of office care $$
Home VisitsPg 37
Time of day Matters
Nursing home Pg 36
Auxiliary Hospital Visits
03.03N
OFEV
OFEVWK
OFNTPM
OFNTAM
$83.40
+43.06
+50.48
+115.74
+115.74
0700-17:00 WD
0700-17:00 WD
Priority call 17:00-22:00
WD
07:00-22:00 WE/STATS
22:00-24:00
24:00-07:00
*record times
Visit LTC
Admit
03.04D
03.03KA
03.03LA
03.03MC
03.03MD
03.03E
+cmxc30
$74.13
$111.20
$148.27
$148.27
$23.80
$108.11
+
+03.03E
A
+03.03E
A
+03.03E
A
+03.03E
A
$42.70
Practice Management Billing . Department of Family Medicine . Fee codes May 28 2015 . Dr Wendy Tink - 18 -
+ cmgp modifiers + 03.01AA time modifiers
Fee codes: After hours out of office Time modifiers Add 03.01AA Page 19, 39
Practice Management Billing . Department of Family Medicine . Fee codes May 28 2015 . Dr Wendy Tink - 19 -
ER, OP, Hospital, LTC, UCC, AACC
Add 03.01AA each direct care 15 min completed
TEVTWKTDES
W/D 17:00 – 22:00W/E 0700 – 22:00Des hol 07.00 – 22:00
22.22/ 15min
TSTTNTPTNTA
Stat hol 07:00 – 22:0022:00 – 24:0024:00 - 07:00
44.43/ 15min
2400 (midnight)
7:00 am 5:00 pm 10:00 pm 2400 (midnight)
TNTA
$44.43/15 min
TEV
$22.22/15 min
TNTP$44.43/15 min
ANY EVENING, NIGHTS
Office Fee Codes: Summary- 20 -
Whole Limited
PallPain
Psych
or
Complex Care Plan
Phone CallsProcedures
Resources: GP Billing Rules and Codes AMA April 1, 2015 ICD 9 Diagnostic codes
Time modifiersCmxc30
orCmgp01+
TimeModifierMultiples
NH / Home Visits /
OB / ER
+ + + +
03.04J Usually add to visit
Time of day
matters!
Visit +
Call back+
Modifiers
Practice Management Billing . Department of Family Medicine . Fee codes May 28 2015 . Dr Wendy Tink
Choose
21
Become a skilled clinician …. … and PRACTICE BILLING … before it really matters!Small groups Fill in dx codes and billing
Patient totals and day total PRIZESPractice Management Billing . Department of Family Medicine . Fee codes May 28, 2015 . Dr Wendy Tink
22
Become a skilled clinician …. … and PRACTICE BILLING … before it really matters!Small groups Fill in dx codes and billing
Patient totals and day total PRIZESPractice Management Billing . Department of Family Medicine . Fee codes May 28, 2015 . Dr Wendy Tink