A. If you are requested to attend at a delivery due to your special expertise, the appropriate billing is a consultation fee (9B for Family Practitioners or 9C for Pediatricians). Otherwise, a family physician should bill a complete assessment (3B). If newborn resuscitation is required, physicians are now eligible to bill the Emergency Resuscitation codes listed in Section A of the Payment Schedule (220A to 223A).
Please note that you cannot bill an assessment/consultation during the same time frame as the resuscitation service (double billing). An assessment/consultation can be billed if it is provided at a separate and/or adjacent time.
For Family Practitioners concerned about MSB rejection of their 9B claims, we suggest noting in the comment section of your claim the words "Requested to Attend at Delivery."
A. Sometimes. This can be allowed when a family physician with special expertise in obstetrics is called in to take over a delivery. What constitutes special expertise? If the "consulting" family physician participates in a Specialist Emergency Coverage rotation for obstetrics, it’s automatically allowed. All other cases must be submitted to MSB with an acceptable explanatory report.
A. Yes. It is appropriate to bill for a cast in circumstances where a backslab is used to immobilize a fracture. This would not apply to the use of prefabricated splints but only in circumstances where a molded cast is applied.
A. Sometimes. The Medical Services Branch has a linkage to WCB, and will automatically reject dual claims. However, there are clearly some circumstances where such dual claims are appropriate. Physicians often combine multiple unrelated services for the convenience of the patient (for example, to minimize a rural patient’s travel time). In such cases, the physician should bill the Medical Services Branch "by report," briefly explaining the services provided.
A. No. Code 42D is confined to the use of electro-cardioversion. The treatment of cardioversion utilizing medications should be billed utilizing the appropriate visit fee codes.
A. No. The current Botox codes are professional fees based upon physicians’ rates of payment for the time, effort, and training required for the procedures. As such, it would not be appropriate to bill for work performed by clinic staff.
A. These should be billed using long term care fees (626A). If the physician needs to see the patient more than once per week, the physician should bill code 5B, plus any appropriate surcharge (and ensure sufficient documentation of the visit). With these types of questions, billing should be guided by the concepts of patient need and the physician service provided, and not by the location of service.
A. All pre-admission complete assessments are insured, even if requested by a third party addiction centre. Family physicians should bill for this service using code 3B. The form is considered to be part of the medical record for the visit, and is therefore included in the 3B billing code.
A. Yes. The Payment Schedule allows for reimbursement to physicians for counseling family members (see page B.2). The appropriate code to bill for this service is codes 40B and 41B. To be eligible to bill this service, the counselling must be provided during a pre-booked separate appointment at which time a medical record is generated. It is expected that this would normally occur in circumstances where the relative has a serious or complex problem. As noted in the Payment Schedule, routine briefing and advice to relatives is considered to be part of the visit service fees.
A. All four of these requests are now covered under the 56A fee code (Report Requested by Cancer Agency or Cancer Screening Program). To ensure payment, it’s important to use the following diagnostic codes:
Screening Program for Breast Cancer
Program for Prevention of Cervical Cancer
Colorectal Cancer Screening Program
Saskatchewan Cancer Agency request for follow-up of registered cancer patient
Q. Are family practitioners eligible to bill code 769A or 762A (major and minor telephone assessment and advice)?
A. Only those family practitioners who are recognized as providing specialty services under the Specialist On Call Coverage Program are eligible to bill these codes.
Q. Is the first visit by a patient to determine whether or not they are a candidate for chelation therapy an insured service or not?
A. Any visit for the sole purpose of determining suitability for an uninsured treatment modality such as chelation is considered an uninsured service and should, therefore, be billed directly to the patient.
A. There are two options for billing depending on the service provided:
It is appropriate to bill the patient directly for the cost of the vaccine if not provided free-of-charge by Public Health.
A. This service is considered to be an insured service and is covered by the Medical Services Branch of Saskatchewan Health. The appropriate code for this service is 37A, since Christian Counselling is acting as an agent for Social Services for the purpose of adoptions.
A. Almost any time your hospital in-patients are discharged. From discussions with the Medical Services Branch, we understand that a significant number of these are not currently billed. If your patient has been admitted for at least 24 hours, and you are responsible for discharging the patient, you can bill this fee on the day of discharge.
For obstetrical cases, you are entitled to bill separately for mother and infant. The code also applies in circumstances where an in-patient is transferred to another hospital/facility or when an in-patient has died. Also, note that this service is payable only once per discharge.
You may also bill this fee if the patient was admitted to a Health Centre for at least 24 hours as a short term acute care patient. Appendix B of the Payment Schedule has some further details.
A. Yes. Code 763A is paid for monitoring anticoagulant therapy. It is generally expected that physicians have an arrangement with their patients to call them should they require adjustment in their anticoagulant dosage or repeat testing. It is understood that physicians may not need to call their patients some months if their INR level is stable and no change is required. The fee is still payable in these circumstances so long as the patient is being actively monitored and supervised on a consistent basis.
A. For Multiple Sclorosis EDS, code 153A can be billed once per year for filling out the request form. This fee is for the form only. The assessment is considered part of the visit service, and you may bill the appropriate consultation or visit fee in addition.
Alzheimer EDS is paid through two separate fees. Code 154A is used for the initial application, while follow-up status reports by phone or fax may be billed using code 155A. Again, these codes do not include the assessment, which should be billed using the appropriate consultation or visit fees.
Ankylosing Spondylitis EDS forms can be billed using code 156A. These EDS requests can be made either by family physicians or specialists.
A. For a Family Practitioner or Paediatrician, the appropriate billing is usually a Complete Assessment (3B or 3C) as it is expected one will fully assess the infant, followed by regular hospital care fees (25B to 28B) for each day the baby remains in hospital.
A Consultation (9B or 9C) rather than a complete assessment may be charged if newborn care is provided on a specific request from the delivering physician, and not as part of a shared call arrangement.
A. The Medical Services Branch has implemented some flexibility in this "once per week" rule. For example, if you visit your nursing home patients on Thursday of this week and Tuesday of next, your claims will not be rejected.
MSB’s computer system has set the minimum number of days between visits equal to five - any fewer and your claims will be automatically rejected. But you may still be able to submit your claims by report.
A situation recently arose where a physician was unable to make his regularly scheduled Friday nursing home visits until Monday. He then immediately resumed his Friday schedule, leaving only 4 days between visits. The claims were rejected, but on resubmission with an explanatory report, they were accepted.
The guiding principle is that physicians should average no more than one nursing home visit per week. Any more and you could be subject to reassessment. And as written in the Payment Schedule, if you need to see a particular patient more frequently, the subsequent visits should be billed using the 5B, provided that all the requirements of a 5B are met (including documentation).
A. No, surcharges are only billable for unscheduled emergency work. The preamble to the surcharge section also states that payment will be made only if the call is "initiated by the patient, or someone other than the physician, on the patient’s behalf."
A. All requests for medical information relating to social assistance are considered uninsured third party requests. In the case of Saskatchewan Community Resources and Employment, the Medical Services Branch has agreed to act as the paying agent when you complete a form and bill code 20A. No similar arrangement exists with First Nations Bands, so you should bill the Band directly for the service.
A. Income security workers for Social Services have been advised that their clients should take a Medical Report Form (Form SSS 1092) to the physician when requesting medical information to support a social assistance claim. The form should indicate the reason for the request and should contain all of the relevant information. Physicians are under no obligation to provide information on a prescription pad or note.
The Department of Social Services uses the medical report to assess a client’s eligibility for social assistance, as well as requirements for medically related items such as special diets.
There is a fee code listed in the Payment Schedule for this service (Code 20A). This code pays for the completion of a Social Services form and can be billed directly to the Medical Services Plan.
A. In April, a new non-co-payment fee was introduced for medicals requested by the SGI Driver Medical Review Unit. The new 74A fee code replaced the previous 72A at almost twice the rate. It is no longer appropriate to bill the patient extra for this service.
Payment for a commercial driver’s medical continues to be the full responsibility of the patient. This fee includes the patient assessment (if necessary) and completion of the form. The new code 805A can be found on page A4 of the guide.
SGI has recently indicated that a large number of commercial drivers’ medicals have been billed in error using code 74A. It is important that billing staff understand the difference between regular and commercial drivers’ medicals; otherwise, the clinic will be presented after-the-fact with an SGI invoice for overpayment, and will have to track down and seek payment from the patient.
While counselling fee codes were introduced by the Section of Family Practice and reside in the "B" Section of the Payment Schedule, they are available to any fee-for-service physician (GP or Specialist) who needs them. Please note that counselling must occur in a booked separate appointment and be fully documented in the medical record. There is a maximum of 30 minutes for third-party counselling (counselling family members regarding a patient) that is billable with these codes. Page B.2 in the Payment Schedule offers further details.
A. No. Tariff recognized that there are circumstances where it is more convenient or appropriate for a physician to remain in the hospital when on call. In the opinion of Tariff, however, an initial surcharge can only be billed in circumstances where the physician actually travels to see the patient. In circumstances where the physician remains within the hospital, it is not appropriate to bill an initial surcharge. It would, however, be appropriate to bill an extra patient seen surcharges for subsequent patients seen after 5:00 p.m. and on weekends. It is also acceptable to bill premiums for these services.
A. Post operative visits (except for those in hospital) can now be billed following any 10 or 42 day surgical procedure, regardless of who performed the surgery. Family physicians and cognitive specialists would generally bill using a partial assessment fee (e.g. 5B). Surgeons would generally use their follow-up assessment code (e.g. 7L).
Suture removal can also be billed following these procedures, using code 898L (for example, if your partner puts sutures in, you can now bill to remove them). When billed with a visit, the suture removal fee is automatically reduced to 75 percent.
A. Code 791A is the appropriate code to bill for calls from private care homes so long as the caller is on the list of "eligibles" found on page A.19 of the Payment Schedule. Code 790A is the appropriate code for similar calls regarding residents in publicly funded long term care facilities.