JCL was recently asked why MRP’s who admit a patient are supposed to bill C122 and C123 for the first and second day after admission as opposed to billing assessments like C603 and C604.
To bill or not to bill?
The short answer is that physicians are allowed 1 major assessment per patient admission (see the General Preamble GP26). This major consult/assessment takes place the first time the doctor sees the patient, generally during admission. All the visits thereafter are subsequent visits for the MRP, payable with the 30% E083 MRP premium. Day 1, day 2, and discharge (C122, C123, C124 ) MRP codes are worth more because the Ministry recognizes that there’s more work in the first few days after a patient is admitted, and that discharge planning and write-up takes more time. Thus MRP’s are not supposed to bill C603 or C604 instead of day 1 and 2 MRP codes. If you compare the charts below, you actually earn a bit more billing C122 & C123 with E083’s instead of the C603 and C604.
(We’re using cardiology in our discussion here – specialty “60” – but you can replace the “60” with your specialty code, for instance “13” for internal medicine codes C133, C134)
|MRP codes||Amount||E083: 30% MRP Premium||Total amount|
|C122 – Day 1 after admission||$58.80||$17.64||$76.44|
|C123 – Day 2 after admission||$58.80||$17.64||$76.44|
|C602 – Daily subsequent visit||$31.00||$ 9.30||$41.30|
|C124 – Day of discharge code||$58.80||$17.64||$76.44|
*E083 is only billable with MRP visit codes noted above, NOT with the assessments in the chart below.
What’s in Assessments?
Assessment codes starting with the C-prefix are for routine assessments – in other words non-urgent care. Once the initial assessment has been done at admission, there is no argument for doing another routine assessment instead of routine MRP visits. Codes such as C605, C675, C603 & C604 are major assessments reserved for physicians doing routine initial assessments for inpatients, not for MRPs who have previously done a major assessment – the MRP codes are meant for that.
|Consults/Assessments for Cardiology||Routine||Amount||Urgent|
|Consult for patient under 17||C765||$165.50||A765|
|Comprehensive 75 minute consult||C600||$300.70||A600|
|Repeat Consultation in under 1 year||C606||$105.25||A606|
|Medical specific assessment||C603||$79.85||A603|
|Medical specific re-assessment||C604||$61.25||A604|
|Complex medical re-assessment||C601||$70.90||A601|
|MRP subsequent visit||C602||$31.00||—|
If the MRP is called to see their own patient urgently, then there is an argument for billing a minor assessment. In this case, the urgent A-prefix A608 code could be billed, with or without special visit premiums depending on the time of day and circumstances. However, if the physician was called for a reason completely unrelated to the principal diagnosis, this could constitute grounds for performing another major assessment during the same hospital admission (eg: A603 with possible special visit). These are irregular occurrences, however, and should never be used to replace routine MRP subsequent visits.
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