Billing Information for a RACE call

UPDATED SSC FEE GUIDE

 

Billing Information for a RACE call

  • Billing code G10001 Urgent Specialist Advice – $60.00 – for calls returned within 2 hours
  • Billing code G10002 Specialist Advice for Patient Management – $40.00/15 minute interval – for non-urgent calls and advice provided to a nurse practitioner

Billing code G10001 – $60.00 – Urgent Specialist Advice for calls returned within 2 hours

 

*As of Nov 1, 2015 – Expand fee to include real-time face to face and video communication to better reflect the way that specialists communicate.

 

Initiated by another Specialist or General Practitioner, this fee is to be used when immediate advice is required. The purpose of this fee is for the specialist to provide urgent real-time advice when the intent of communication is to replace the need for the specialist to see the patient in person. The consulting specialist is responsible for ensuring that an appropriate communication modality is used to meet the medical needs of the patient.   Specialists can bill this item when they provide telephone advice to the initiating physician within two hours of initiating request. Notes:  Payable to Specialist Physicians for urgent real-time advice (including telephone, video technology or face to face communication) regarding assessment and management of a patient but without the consulting physician seeing the patient.

  • Conversation must take place within two hours of the initiating physician’s request. Not payable for written communication (i.e. fax, letter, e-mail).
  • Includes discussion of pertinent family/patient history, history of presenting complaint, and discussion of the patient’s condition and management after reviewing laboratory and other data where indicated.
  • An adequate medical record/chart entry, including time of initiating request, time of response as well as advice given and to whom, is required.
  • If a call is from Out of Province it follows ALL the rules of Reciprocal Billing. That means the patient’s full contact info has to be included along with the Provincial Billing Number. i.e. full address.
  • Include the practitioner number of the practitioner requesting advice in the referred by field when submitting claim.

Not payable for situations where the purpose of the call is to:

  • book an appointment
  • arrange for transfer of care that occurs within 24 hours
  • arrange for an expedited consultation or procedure within 24 hours
  • arrange for laboratory or diagnostic investigations
  • inform the referring physician of results of diagnostic investigations
  • arrange a hospital bed for the patient
  • Limited to one claim per patient per physician per day.
  • Out-of-Office Hours Premiums and Rural Retention Premiums may not be claimed in addition.
  • Not payable if there is a paid visit/service for the same condition by the same practitioner in the previous 180 days.
  • Not payable to physician initiating call.
  • Not payable in addition to another service on the same day for the same patient by same practitioner.
  • No claim may be made where communication is with a proxy for either physician (e.g. nurse or assistant).
  • Cannot be billed simultaneously with salary, sessional, or service contract arrangements.

Billing code G10002 – $40.00/15 minute interval – Specialist Advice for Patient Management for non-urgent calls and advice provided to physicians, nurse practitioners and allied care providers

 

*As of Nov 1, 2015 – Expand fee to include real-time face to face and video communication to better reflect the way that specialists communicate. See link above for more information.

 

Initiated by another Specialist, General Practitioner or Allied Care Provider, this fee is to be used when a referring provider needs non-urgent advice and guidance with the management of a patient. The purpose of this fee is for the specialist to provide real-time advice when the intent of communication is to replace the need for the specialist to see the patient in person. The consulting specialist is responsible for ensuring that an appropriate communication modality is used to meet the medical needs of the patient.   Specialists can bill this item when they provide telephone advice to the initiating provider within one week. Notes: Payable to Specialist Physicians for urgent real-time advice (including telephone, video technology or face to face  communication) regarding assessment and management of a patient but without the consulting physician seeing the patient.

  • Conversation must take place within 7 days of initiating physician or allied care provider’s request.
  • Includes discussion of pertinent family/patient history, history of presenting complaint, and discussion of the patient’s condition and management after reviewing laboratory and other data where indicated.
  • An adequate medical record/chart entry, including time of initiating request as well as advice given and to whom, is required.
  • Include start and end times in the patient’s chart and time fields when submitting claim.
  • Include the practitioner number of the physician or allied care provider requesting advice in the “referred by” field when submitting claim. (For allied care providers not registered with MSP use practitioner number 99987).

Not payable for situations where the purpose of the call is to:

  • book an appointment
  • arrange for transfer of care that occurs within 24 hours
  • arrange for an expedited consultation or procedure within 24 hours
  • arrange for laboratory or diagnostic investigations
  • inform the referring physician of results of diagnostic investigations
  • arrange a hospital bed for the patient
  • Limited to two services per patient per physician per week.
  • Out-of-Office Hours Premiums and Rural Retention Premiums may not be claimed in addition.
  • Not payable if there is a paid visit/service for the same condition by the same practitioner in the previous 30 days.
  • Not payable to physician initiating call.
  • Not payable in addition to another service on the same day for the same patient by same practitioner.
  • No claim may be made where communication is with a proxy for the consultant physician (e.g. nurse or assistant).
  • Cannot be billed simultaneously with salary, sessional, or service contract arrangements.

Still have Questions?

Link to SSC Frequently Asked Questions

If you are unsure about how to bill the fees, you can receive trusted advice from Doctors of BC’s Lea Harth, Fee Guide Assistant lharth@doctorsofbc.ca or call 604-638-2827 or MSP/HIBC Provider Programs 604-456-6950 (Vancouver) or 886-456-6950 (rest of the province).

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