GPSC Fee Revisions Key Points Summary and Sept 18 update

On August 1, 2015 the General Practitioner Services Committee (GPSC) made revisions to the wording of some GPSC fees. Simplification of documentation requirements for the complex care fee were  made Sept. 18.

Here are some of the key points:

1) There is no longer a requirement to give flowsheets to patients. Offer self-management supports as appropriate for individual patients.

GPSC notes:  “Must have chart-documented provision of a clinically appropriate level of guideline-informed care in the preceding year, including patient self-management supports as appropriate for individual patients. Sharing of flow sheets no longer required, although the use of flow sheets (paper or electronic) as a tool for documentation is still considered an appropriate confirmation of care provision.”

2) For annual billing of CDM incentives, one of the  two visits required in the preceding year can be a GPSC telephone visit or a group medical visit.

GPSC notes: “There must be at least 2 visit fees (office; prenatal; home; long term care; only one of which can be a GPSC Telephone Visit or a Group Medical Visit) in the 12 months prior to billing the CDM incentive. Visits provided by a locum are included; however, if the 2-visit requirement includes a locum visit, an electronic note must be submitted with the claim.”

3) Start and end times are now required for billing submission for mental health planning fees (14043) , palliative planning fees (14063) and mental health management fees (14044, 14045, 14046, 14047, 14048). The start and end times should also be recorded in the chart.

GPSC notes: “Minimum requirement of 30 minutes face-to-face time in addition to visit time (home/office) same day. Both chart and claim must state start and end times of the total service (planning + visit).”

4) For the Complex Care Planning fees 14033 and 14075, the chart note must include the total of : time spent planning (face-to-face, chart review and documentation) plus time spent for the required same day visit fee.  Of this total, the majority must be face-to-face, and this majority time must also be charted.

GPSC notes: “Minimum required time 30 minutes to review chart and create the care plan jointly with the patient and/or their medical representative. The majority of the time must be face-to-face. Documentation in the patient chart of total time spent in planning (face to face; review) and medical visit is required.”

So, document a minimum of 35 minutes of total work time for the combined visit and planning.
The 35 combined minutes should include:

  • at least 20 minutes of physician-patient face-to-face time
  • plus any combination of:
    • chart review
    • more physician-patient face-to-face time
    • encounter documentation
    • allied care provider time with patient

For example: You spend 20 minutes face to face with the patient and 15 minutes on chart review and documentation.
Document: total time = 35 min, face to face time = 20 min

5) GP’s on Alternate Payment who bill encounter codes are now requested to use a different set of CDM codes when submitting for these services.

GPSC notes:  “New codes for GPs who bill encounter codes are available retroactively to January 1, 2015. Please wait until after August 4, 2015 to resubmit any rejected CDMs with these new codes retroactively. Submission code “A” may be used for any claims over 90 days of age. The 2-visit requirements are subject to review of encounter codes to confirm provision of care.”

For the full details read GPSC’s summary of the changes.

SGP is interested to hear what you think of the GPSC’s changes. Send us your thoughts at: