Physicians billing with subspecialty designations

Issue: BCMJ, vol. 59 , No. 10 , December 2017 , Pages 501 Billing Tips

Audits have revealed that physicians who have subspecialty designations may be billing consults out of one section of the payment schedule, and subsequent office/hospital visits (and other services) out of another section for the same patient.

Section C.16 of the General Preamble of the MSC Payment Schedule states:

A specialist recognized in more than one specialty by the College of Physicians and Surgeons of British Columbia should bill consultation and referred items under the specialty most appropriate for the condition being diagnosed and/or treated for that referral/treatment period.

If you have dual specialities, keep in mind that:

At each visit, it is important to identify which specialty/subspecialty is most relevant to the patient’s chief complaint or the main issue being discussed.
In most cases, for an individual patient, consultations and subsequent office/hospital visits should be billed under the same specialty/subspecialty since all of these services are usually related to the same condition.
You should bill the fee item most relevant to the service being delivered.
You should not bill the higher value fee item unless it is justified.

Always refer to the MSC Payment Schedule (or the Doctors of BC Guide to Fees) and its Preamble for interpretation of all fees.
—Lorne Verhulst, MD
Chair, Patterns of Practice Committee

hidden


This article is the opinion of the Patterns of Practice Committee and has not been peer reviewed by the BCMJ Editorial Board.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

Lorne Verhulst, MD. Physicians billing with subspecialty designations. BCMJ, Vol. 59, No. 10, December, 2017, Page(s) 501 - Billing Tips.



Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.


For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply

CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Enter the characters shown in the image.