Routine visits to the facility:
00114 Residential care visit fee
Can bill this every 2 weeks as warranted. However, if more frequent visits need to be made, MSP will pay for them, but with the extra 00114 you must give the diagnostic code for why you had to see the resident e.g. UTI, pneumonia, delirium, sepsis, CHF and then give a short explanation such as: intercurrent illness – UTI, intercurrent illness – delirium.
13334 First visit of the day bonus
Bill for the first resident you see that day. Must be billed with a 00114. Only one can be billed per day.
00127 Visit for terminal care
This can be submitted before the resident dies and can be billed if daily visits are needed. From the time the patient is deemed palliative up to 180 days prior to death. Visits must be documented. You may wish to visit dying residents first so you can bill the higher fee. The diagnostic code must demonstrate a terminal illness.
If seen as the first patient that day, you may bill the 13338 bonus (cannot bill a 13334 and 13338)
Yearly Complete Exams
Complete examination – out of office 16201 (age 60 – 69)
17201 (age 70 – 79)
18201 (age 80+)
Telephone call for an order or concern:
13005 Telephone advice
If a nurse or other healthcare professional calls to discuss a resident or needs an order that can be done over the phone you can bill this fee. Do not bill if you have already billed another service (eg not with 114, complete, 14077).
Called out to see the resident:
00115 Residential care visit fee if called to see (one resident only)
If called between the hours of 0800 and 1800 hours to see the resident you can bill this fee. The time of the call is important as even if you do the visit after 1800 hrs you can only bill the 00115 fee. Any other residents seen at the visit is 00114.
Called after hours to see resident:
When called after hours to attend to an ill resident, you can bill the “out of office” visit PLUS the surcharge. You would not bill a 00114.
16200 Visit - out of office (age 60 - 69)
17200 Visit - out of office (age 70 - 79)
18200 Visit - out of office (age 80+)
You can also bill the call out charges if the following criteria are met: You are called specially to see the resident. It is a non-elective medical reason for the visit. You must travel from home or office to render the service. The call was made out of office hours (as above). **(When using Dr. Bill, if you select “Call Out” in your billing these fees will be automatically added for you) **
Call out charges:
01200 Evening: call placed 1800-2300hrs
01201 Night: call placed 2300-0800 hrs
01202 Saturday, Sunday and Statutory Holidays: 0800-1800
The call out charges apply to the first resident seen. Other visits can be billed as out of office visits but must be considered medically necessary and cannot wait until your routine visit.
If the time you spend assessing and treating the resident you were called to see exceeds 45 minutes you can bill the following:
Non-Operative Continuing Care Surcharge: When using Dr. Bill, select “After Hours” to have these codes automatically added for you. You will enter the times seen for each patient at the end of a 30 minute block and the units will be automatically calculated. Please enter CCFPP in the notes field to indicate that the patients were seen as part of the same call out and you will not be deducted the 30 minute refractory period.
Resident care conferences/meetings:
14077 Facility Patient Conference Fee per 15 minutes
This fee is for attending your resident’s care conference. Max/day/resident = 30 minutes; max/year/resident = 18 units. You can also bill the fee (with the same restrictions) if asked to meet with other heatlh professionals (pharmacist, dietition, etc.) about a resident on an informal basis via phone or in person. Document which healthcare providers are at the meeting (e.g. CNL, RN, MD met to discuss Mrs. C.’s agitation).Can bill visit fee (00114) in addition if medically indicated. Must indicate stop/start time of the conference and V15 code (frail elder)
Telephone Management Fee (GP for Me Incentive): 14076
A clinical phone discussion between pt’s representative or family and health professional about the resident. Can bill with 14077 if done on same day. Cannot bill with 114, or other service.
Dealing with distress in resident / family; and/ or psychiatric counselling and/or completion of MMSE
Individual counselling - out of office
16220 (age 60-69)
17220 (age 70-79)
18220 (age 80+)
Discussion with resident, or family member about resident’s medical condition e.g. terminal illness, progressive dementia, resident behaviour that is distressing ,etc. You can bill under the resident’s MSP number or under the relative’s MSP number. The session must be in person and must be at least 20 minutes. Max of 4 per year. Cannot be billed in addition to visit fee (00114) unless you billed the counselling fee under the relative’s MSP number.
Chronic Disease Management
These can be billed per calendar year. HBP (14052) cannot be billed in combination with the other codes.
Diabetes: 14050 Dx 250
Heart Failure: 14051 Dx 428
HBP: 14052 Dx 401
COPD: 14053 Dx 491, 492, 494, 496
14018 To obtain advice, you can call the RACE hotline and speak with a specialist.