To reduce the possibility of additional charges being levied to your account, please refer to the information below as a guide to ensuring that complete and accurate information is provided for data entry. Below we have identified some of the difficulties we have encountered in the processing of claims.
- Please ensure that you provide appropriate diagnostic coding (ICD) for each fee code billed (each fee code on a separate line with the corresponding ICD code). Our data entry operators will otherwise assign a very general ICD code which may not be as accurate as you'd like it to be. Please note that generic, three digit 780 codes (780, 781, etc) will not support visits and procedures billed at the same time, such as a pap and an office visit or a laceration and an office visit. They will often be refused for complete physical examinations as well. ICD booklets are available from Provider Programs at MSP (phone: 604-806-0234; options 2,3 and 0).
- Please calculate the number of services you are billing. This information is often missing on billings for continuing-care-surcharges (1205,1206,1207) and for oxy top up (4119).
- If CCFPP is applicable to a continuing-care-surcharge, please make the necessary notation in the narrative column of your billing sheet. It should not be written in place of a fee code, but in addition to the fee code and number of services.
- Times, both start and end, should be noted on the line they pertain to. For out-of-office-hour call-outs, the start time is the time you were called, and the end time is the time you arrived. This time should be noted on the same line as the 1200, 1201 or 1202. Additional start and end times are required for surcharge codes 1205, 1206 and 1207. The start time is when you arrived and the end time is when you stopped rendering care. For example: 310x1 1200 x 1 l8:00-l8:30hr 1205 x 1 l8:30-l9:30hr (first 1/2 hour not applicable with a call-out)
- ER sheets should be separated by date of service, not by shift or by date of admittance. This is a problem when you worked over a midnight shift. Again, claim entry is delayed while we delete claims incorrectly entered on a particular date of service because they were stapled together.
- When working with ER sheets, our first step is to pull out all sheets that are; WCB related, non-residents, or missing patient information. Please note that infants are covered under their mom's PHN only for the their month of birth. plus the two following months. Furthermore, we must be provided with mom's surname, even if the infants surname is not actually the same. We frequently get sheets from doctors who have accepted the mom's number for children who are several years old.
- Dates of service on billing sheets need to be noted in the date column. If you have multiple claims for the same patient, please note the date changes in the proper column. There should be no dates in the right hand narrative column of your sheets.
- Please include referring practitioner numbers. Our software does not provide us with information regarding a physician's specialty and it is therefore often very difficult to decipher which doctor is being referred to or from, given only a name.
- There can be a huge discrepancy between admit times and the time a patient is actually seen in the ER, such that your fee codes do not match the admit times. Please provide an actual start time when you a noting your fee code and ICD.
Some Basic Guidelines which need clarification
- A visit and a procedure must be supported by two significantly different ICD codes. Do not use generic three digit codes.
- A mini tray fee (00044) is not billable with a pap (14560) unless you have used a DISPOSABLE speculum AND a cyto brush.
- Call-outs are not payable unless you leave to render care within a reasonable period of time. A call received at 18:00hr on Friday resulting in a visit at 08:00hr on Saturday, does not qualify.
- Multiple ER visit fees on the same date of service are not payable unless the patient left the facility and later returned. You cannot bill in this manner if you left to attend other patients, waited for labs etc, and then returned to reassess the patient. The visit fee covers care during that admittance.
- Laceration repairs are not accumulative. If you repair a 3 cm and a 4 cm laceration you cannot bill a 13612 x 7. You must bill 13611 x 1 and a second 13611 x 1, with a note that says 'second area'. Furthermore, you cannot add up layered closures.
- Please ensure notes are provided to support 081 and 082 claims. You must provide two separate notes if you are billing both fee codes. Notes for support of fee code 081 must include the word 'resuscitation'.
- A complicated laceration (6075,6076, 6077) can only be billed if:
- it was a layered closure that involves necrotic tissue requiring debridement
- OR there is tissue loss
- OR wound requires tissue shift aside from minor undermining or advancement flaps
- OR wound is skived, ragged or stellate where excision of margins is necessary to obtain 90 degree closure
- OR wound is contaminated and requires excision of foreign material
- OR laceration requires layered closure and key alignment sutures involving critical margins of the eyelid,nose, lip, oral commissions or ear
- OR laceration involves the subcutaneous tissue requiring alignment and repair of cartilage and layered closure.
Please note that a layered closure is only supportable IF: the defect would require too much tension for an acceptable primary closure; it involves at least two layers of deep dissolving sutures to close off dead space and take tension off the would. Note that a deep cartilage closure is also considered a layered closure. Your note record should use the wording above, as specified by MSP.