Advice about a patient in community care (fee item 13005)

Issue: BCMJ, Vol. 58, No. 8, October 2016, page(s) 484 Billing Tips
Keith J. White, MD

Fee item 13005 (advice about a patient in community care) applies to residential, intermediate, and extended care patients and also includes patients receiving home nursing care, home support, or palliative care at home. It is defined in the Doctors of BC Guide to Fees as advice given by telephone, fax, or in written form about a patient in community care in response to an enquiry initiated by an allied health care worker* specifically assigned to the care of the patient (including completion of faxed medication review with orders, up to twice per calendar year).

Audits reveal that physicians frequently bill fee item 13005 incorrectly. Services that do not qualify for this fee include:
•    Prescription renewals or pharmacist’s adaptations.
•    Booking for appointments.
•    Advice given in response to enquiries from a patient or their family.
•    Advice provided by physicians who are employed by or who are under contract to a facility and whose duties would otherwise include provision of this care.
•    Advice provided by physicians working under salary, service contract, or sessional arrangements whose duties would otherwise include provision of this care.
•    Advice provided by physicians who are on site, on duty in an emergency department, who are being paid at the time on a sessional basis, or who are working at the time as hospitalists.

Medical inspectors look for proper documentation in the patient’s record to support the criteria to bill fee item 13005. There must be documentation in the medical record of the date of service, name and position of the enquiring health care worker, and the advice given. Alternatively, the original of a fax or a copy of written advice will suffice to document these services. To simply state “no advice given” in the patient’s chart or “thank you” on the fax sheet or a simple refill order with no documentation that the medications were reviewed would not qualify you to bill for these services.

Always refer to the Doctors of BC Guide to Fees and its preamble for interpretation of all fees.
—Keith J. White, MD
Chair, Patterns of Practice Committee

* Allied health care workers are defined as home care coordinators, nurses (registered, licensed practical, public health, psychiatric), psychologists, mental health workers, physiotherapists, occupational therapists, respiratory therapists, social workers, ambulance paramedics, and pharmacists.

This article is the opinion of the Patterns of Practice Committee and has not been peer reviewed by the BCMJ Editorial Board. For further information contact Juanita Grant, audit and billing advisor, Physician and External Affairs, at 604 638-2829 or jgrant@doctorsofbc.ca.

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