Below is the preamble to the MSP billing guide for psychiatrists:
1. Time Units
Some psychiatry fee item descriptions specify nominal time units of 15/30/45/60 minutes. For these listings to be applicable, the psychiatrist must spend at least 12.5 out of each 15 minutes actually engaged in the designated activity for that fee (i.e., 25 out of 30 minutes, 37.5 out of 45 minutes, 50 out of 60 minutes). The designated activities are:
Psychiatric treatment, family therapy and group psychotherapy:
- actual patient/group contact time;
- billing for individual therapy is permitted for only one person within a specified time frame;
- psychiatric treatment or counselling by telephone is not an insured service; and
- psychoanalysis is not an insured benefit under the Plan.
Patient management conference:
- actual meeting time.
2. Psychiatric Treatment
Psychiatric treatment is defined as a series of medical interventions carried out by a psychiatrist trained to treat mental, emotional, and psychosomatic illness through a relationship with the patient in an individual, group, or family setting, utilizing verbal or non-verbal communication with the patient.
Psychiatric treatment always entails continuing medical diagnostic evaluation and responsibility and may be carried out in conjunction with drug and other physical treatments. Psychiatric treatment/group psychotherapy recognizes that the psychological and physical components of an illness are intertwined and that at any point in the disease process psychological symptoms may give rise to, substitute for, or run concurrently with physical symptoms and vice versa.
Family/conjoint therapy and group psychotherapy are defined as psychiatric treatment rendered to a family or other group.
Where a therapy session extends beyond one (1) hour in a day, a written explanation of need is required by the Plan. Typical situations are:
a) patient is from out-of-town;
b) emergency or like situation;
c) extended time required due to nature of clinical problem (explanation needed in each such case); and
d) a particular type of psychiatric therapy is being rendered requiring extended sessions.
Approval from the Plan will be necessary in each such case.
Psychiatric treatment/psychotherapy sessions in excess of two (2) hours in any one week require an explanation of need to the Plan and approval from the Plan in each such case. Typical situations are:
a) patient is from out of town;
b) emergency or like situation;
c) patient in an acute care facility.
3. Prolonged Time-Intensive Psychiatric Treatment
The BC Psychiatric Association has adopted the following principle:
Due to the unmet demand for psychiatric services, prolonged time- intensive psychiatric treatment must be provided only to the extent that it is justified and cost-effective in the context of limited psychiatric treatment resources and waiting lists.
4. Referral For Prolonged Psychiatric Treatment
1. Continuation of payment of specialist fees beyond six (6) months is dependent on re-referral by a physician. This procedure is required in all specialties and is, in fact, a requirement of the BC Medical Association rather than of the Medical Services Commission who, however, have agreed to accept this as an adequate procedure for ensuring the need for continuing medical care by the specialist.
2. While the judgment concerning the medical necessity of continuation of psychiatric treatment may, in effect, be that of the psychiatrist, the referring physician must concur to ensure continued payment at specialist rates. In practice, it would be advisable for the specialist who sees the need to continue treatment beyond six (6) months to ensure that the referring physician is contacted just prior to that time and to maintain contact with the referring physician’s office until he/she is sure that a referral has been sent.
3. Re-referral at the six (6) month interval does not necessarily require a visit by the patient to the referring physician, who can, in effect, send in a “no charge” re-referral. It is obvious; however, that the referring physician must be aware of the need for continuing care by the specialist, and this would be best achieved by the specialist sending the referring physician a written report of his/her treatment, of the present status of the patient and of the prognosis.
4. In cases where confusion is likely to arise; for example, where the patient has changed his/her general physician from the time of the original referral, or when the specialist is unable to ensure that a re-referral is being made, it would be advisable for the specialist to cover the situation by writing directly to the Medical Advisor of MSP concerned, indicating the circumstances and supplying whatever information he/she thinks necessary to ensure continued payment at specialist rates.