Hospitalists, from an OHIP billing standpoint, are rather limited in their options. Outside of the admission assessment and special codes for the first two days after admission and the day of discharge, hospitalists, or Most Responsible Physicians (MRPs), are constrained to billing for daily subsequent visits. Even with the E083 MRP premium, these daily visits pay around $40. Hospitalists, therefore, should be aware of other codes they are eligible to bill as MRP that better reflect all the diverse tasks they are required to perform.
The following is a summary of the most common additional codes payable to MRP Hospitalists.
K002 – Family Interview ($62.75/unit)
One of the circumstances often encountered by Hospitalists is the need to interview the relatives of a patient to discuss treatment options. When this discussion is a separately booked appointment that lasts at least 20 minutes, the physician may be eligible to bill a K002 Family Interview code (page A19 in the Schedule of Benefits). This code pays $62.75 per unit (20 min = 1 unit, 46 min = 2 units, 76 min = 3 units, etc). These interviews cannot be used when the sole purpose of the interview is to obtain consent, or when the information being obtained is normally gathered during a consultation or assessment.
Given that in the definition of this code the interview must be separately booked, a discussion that takes place with the family while the physician is performing routine rounds would not be applicable as a Family interview; that is, it is not a payable OHIP service. If the physician rounds on the patient, however, and feels an interview should take place to discuss the course of treatment, an interview booked with family for later that day or another day would meet the requirements of the Family Interview code.
K002 vs K015 ($62.75/unit) – Family Interview versus Family Counselling
Also, it’s important to differentiate between a “family interview” (K002) and “family counselling” (K015 – page A15 in the Ontario Schedule of Benefits). If a hospitalist meets with a family of catastrophically or terminally ill patient and spends time counselling them, this is a payable service (K015) but it’s not payable with daily MRP codes. The physician must then decide whether to bill daily MRP codes or Family counselling codes.
K121 – In-Patient Case Conference ($31.35/unit)
When the MRP meets with at least two other allied health professionals about a patient, and the ensuing discussion lasts at least 10 minutes and is separately booked, K121 (page A24 in the SoB) is eligible for payment. This code pays $31.35 per unit (10 min = 1 unit, 16 min = 2 units, 26 min = 3 units, etc). The MRP can bill this code four times per patient in a twelve month period, with a maximum of 8 units per occurrence.
Hospitalists need to be aware of the record keeping requirements with K121. Specifically, the start and stop times, the participants involved, and the outcome of the conference must all be included in the common hospital record of the patient. Please note that bullet rounds or educational rounds are not considered case conferences – a case conference is intended only for discussing and directing the care of an individual patient.
G512 – Palliative Care Case Management Fee ($62.75/week)
If an MRP is providing supervision of palliative care to a patient, the physician is entitled to bill G512 (page J82 in the Schedule) once per week starting midnight Sunday. Included in this fee is the monitoring of the patient, discussion with the patient, patient’s family, or patient’s representatives on the phone or in person, and arranging assessments, therapy, and procedures for the patient. This service is payable once per week. If a patient is transferred from one MRP to another during the week, the MRP who cared for the patient longer is eligible.
Because hospitalists are involved in the daily care of admitted patients, they frequently need to fill out forms for these patients. The most common forms we see are the Home Care Application, MTO license form, and the Long-term Care Form.
- K070 ($31.75) page A40 – Home Care Application – This fee is for the MRP who completes and submits an application for Home Care to the Community Care Access Centre (CCAC).
- K035 ($36.25) page A40 – Ministry of Transport Form – This fee is for the mandatory reporting of a patient’s medical condition to the Ontario Ministry of Transportation.
- K038 ($45.15) page A41 – Long-Term Care Application – This fee is for the completion and submission of a health report form to a CCAC when a patient is applying for admission to a Long-Term Care facility.
Check back for more on Hospitalist billing in upcoming posts.