Bill FFS - READ THIS
Dear EM Billers of BC,
The new fee items for Emergency Medicine Specialist Patient Management/Follow-Up and Emergent telehealth advice from an emergency physician when requested by a physician or allied health provider were approved at Sept 22, 2023 Board meeting.
The Amendment and Clarification (A&C) letters were sent to MSP on Sept 29th.
They will likely take another 3-6 months from then to go through MSC and come into play.
The new code formerly known as the 00108 was approved at tariff but now needs to be advanced to the board and go through the process above and hence again we are looking at approximately 4-8 months considering Xmas. A Note Record will be required with the new code for each submission for manual adjudication (aka read "delay in payment”). So feel free to continue to submit 00108 codes but ensure you are submitting with an appropriate note record and meeting the code as it is outlined below.
Any pending ones will likely need to be resubmitted with the note record so you can prepare for resubmission by preparing your note record ahead of time if you feel the need.
The new code reads:
PXXXX1 Emergency medicine reassessment.....................................................................$32.33 Notes:
- i) Payable for essential additional visits by the same physician to a patient in the emergency department at least two hours after 01810, level II emergency care fee (01812, 01822, 01832, or 1842) or XXXX1; or three hours after a level III emergency care fee (01813, 01823, 01833, or 01843).
- ii) Not payable for observation alone or for review of laboratory results/imaging without further reassessment of the patient and/or modification of the treatment plan.
- iii) The claim must include an explanation of the medical necessity for the visit in the note record.
MSP has also drafted corresponding amendments to the Section Preamble for Emergency Medicine for the Committee’s review and approval:
6) Reassessment of patients by the same physician at least two hours after either 01810 or a level II emergency care fee (01812, 01822, 01832, or 1842), or at least three hours after a level III emergency care fee (01813, 01823, 01833, or 01843), may be billed as XXXX1. This fee is not payable for simple observation or for review of laboratory results/imaging without further reassessment of the patient and/or modification of the treatment plan.
If the patient’s condition has deteriorated significantly, or if they are seen for new and unrelated condition, the appropriate level fee may be claimed.
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