Billing Codes
Call Out - Night 1201
Surcharge - 1206
VISIT-OUT-OF-OFFICE CODE
CONSULTATIONS OUT-OF-OFFICE CODE
COMPLETE EXAM OUT-OF-OFFICE CODE
Documentation
Procedures
Call Out - Night 1201
- Applies from 23:00 – 08:00
- Need to be called in from out of the hospital.
- Need to be on-site
- Can be used to start at 23:00 (01:00 if new schedule is approved), if you have multiple calls and would like to see patients before you leave the hospital. Simply leave the hospital and come back in, if you want to literally do it.
- Second visits are not recovered for the hospitalist program (17:00 – 23:00) as they are rejected (108D code), so if you have done the work, make it work for you by submitting billing through FFS.
- Further billing requirements through your billing software:
- Start and end time (rounded to 15 minutes)
- Code covers 30 minutes, so 23:00 – 23:30, 23:30 – 23:59, 03:15 – 03:45
- Time starts when called.
- Indicate NIGHT in billing
- Requires additional visit +- procedure code.
- Can be used on multiple occasions through the night if you have to return to the hospital, but 45 minutes need to lapse between call outs.
- Example:
- Nurse phones you at 23:10 (01:10 if schedule approved) for a patient that is SOB. You return to the hospital to see the patient. You do your assessment, request a stat CXR and labs. Patient is stable but requires an increase in Oxygen and possibly aspirated. You remain at the bedside until 23:40 to review the results and ensure patient is stable, while you review the test results.
- Call out 1201: 23:15 – 23:45
Surcharge - 1206
- Can be used to extend the time of a call out. Requires call out during MOCAP time, before this can be billed.
- Can be used to see multiple patients when called out.
- Use if > 30 minutes lapse since call out.
- Can be used on 1 patient or multiple patients.
- Needs to be on-site
- Billing Requirements:
- Start and end time needed (needs to start when other time ends)
- 30 minute increments
- Requires additional visit +- procedure code
- Requires CCFPP to be in the billing note section
- CCFPP = (Continuous Care From Previous Patient)
- Example:
- Nurse phones you at 02:10 for a patient that is SOB. You return to the hospital to see the patient. You do your assessment, request a stat CXR and labs. Patient is stable but requires an increase in Oxygen and possibly aspirated. You remain at the bedside until 03:10 to review the results and ensure patient is stable, while you review the test results and start antibiotics and fluids.
- At 02:50, you are called to regarding a patient with chest pain. You request a ECG and stat troponins. You arrive at the bedside at 03:15 to review the patient and the ECG. The ECG looks ok, the TROP returns positive at 03:45, you request a second trop 1 after the first and this is available at 05:45. The patient settles with nitro spray and morphine, but you stay there while you review 3 other patients that nurses are concerned about. You leave at 06:00.
- Example of billing:
- 1201 – 02:15 – 02:45 – Night
- 18200 – night (patient 1)
- 1206 – 02:45 – 03:15 – Night, CCFPP
- 18200 – night (patient 1)
- 1206 – 03:15 – 03:45 – Night, CCFPP
- 17200 – night (patient 2)
- 1206 – 03:45 – 04:15 – Night, CCFPP
- 16200 (patient 3)
- 1206 – 04:15 – 04:45 – Night, CCFPP
- 16200 (patient 3), 13611 (sutures)
- 1206 – 04:45 – 05:15 – Night, CCFPP
- 15200 (patient 4)
- 1206 – 05:15 – 05:45 – Night, CCFPP
- 15200 (patient 4)
VISIT-OUT-OF-OFFICE CODE
- This code have the lowest risk to be flagged for an audit and can safely be used to keep documentation short.
- Code is based on age of the patient. 13200, 15200, 16200, 17200, 18200
- Does not require time as billed with call out or surcharge
- Further billing requirements through your billing software:
- Indicate NIGHT in billing
- Can bill multiple patients if seen between the hours of the call out or surcharge
- Example:
- Nurse phones you at 23:10 (01:10 if schedule approved) for a patient that is SOB. You return to the hospital to see the patient. You do your assessment, request a stat CXR and labs. Patient is stable but requires an increase in Oxygen and possibly aspirated. You remain at the bedside until 23:40 to review the results and ensure patient is stable, while you review the test results.
- Call out 1201: 23:15 – 23:45
- Visit: 18200 (89-year-old)
- Example:
- While you assess the aspiration patient, the nurse request you to review an antibiotic order. You review the patient’s chart and make changes.
- You remain on site until 23:40.
- Visit: 17200 (72-year-old)
- Other notes:
- Visits differ from a consultation or complete examination because consults/exams require a full history and complete exam while a visit requires a partial or regional exam. For example, when you see a new patient you’d give a full examination but when you’re seeing a regular patient for a complaint (like a cold, headache, etc.) you’d bill a visit.
CONSULTATIONS OUT-OF-OFFICE CODE
- Consultations can only be billed every 6 months, so refrain from using this billing code as the program will use a 116 when the patient is admitted.
- DO NOT USE this code
COMPLETE EXAM OUT-OF-OFFICE CODE
You can only bill for a consult or a complete examination once every 6 months. If you happen to see the patient again within the 6 months you need to add a note in the note field of the claim telling MSP what the medical necessity was and why you had to see them again. MSP will then review the claim and decide if it’s eligible or not.
- DO NOT USE this code
Documentation
- When billing these codes, you will be at risk of being audited. Either randomly or as a result of being flagged.
- This means that you need to clearly stipulate the times in your notes that you attended to the patient.
- MUST: Stipulate call out time and time when patient was seen.
- MUST: Document times in note when patient was assessed as per your billing note. Please note that you can make notes later in the EMR, but the times in the your note need to be exactly or very close to that of your billing notes.
Procedures
- Procedures can be billed in conjunction with the VISIT code.
- Procedures can be really tricky, but make sure that you add 13611 code in your favourites of your billing software. This is the laceration code with local anaesthesia for the time that you are called to suture a head wound from a fall.
- Use the OPEN WOUND ICD-9 CODE in conjunction with the claim as it can not be same ICD-9 as your VISIT code.
After hour billing
To optimize your overnight billing, use the codes on the left. Please ensure that you enter the codes correctly in the billing software that you are using to avoid rejections. You need to ensure that you add the relevant description in the billing note, for example CCFPP etc.
