Recent audits have revealed that physicians may be claiming fee item 14033 (complex care) when there is no confirmed diagnosis of a second chronic condition.
Fee item 14033 was developed to compensate GPs for the management of complex patients residing in the community who have documented confirmed diagnoses of two chronic conditions from at least two of the eight categories listed below.
Eligible complex care condition categories:
1. Diabetes mellitus (type 1 and 2).
2. Chronic kidney disease.
3. Heart failure.
4. Chronic respiratory condition (asthma, emphysema, chronic bronchitis, bronchiectasis, pulmonary fibrosis, fibrosing alveolitis, cystic fibrosis, etc.).
5. Cerebrovascular disease, excluding acute transient cerebrovascular conditions (e.g., TIA, migraine).
6. Ischemic heart disease, excluding the acute phase of myocardial infarct.
7. Chronic neurodegenerative diseases (multiple sclerosis, amyotrophic lateral sclerosis, Parkinson disease, Alzheimer disease, brain injury with a permanent neurological deficit, paraplegia or quadriplegia, etc.).
8. Chronic liver disease with evidence of hepatic dysfunction.
There must be supporting documentation in the patient’s medical record (i.e., a diagnostic test or consultation report) for both chronic conditions to meet the criteria to bill fee item 14033. Submitting a claim under 14033 when there is no confirmed diagnoses for both conditions could be considered deliberate misbilling. Deliberate misbilling can result in de-enrollment from the Medical Services Plan. Also, indicating a false diagnosis may have a negative impact on the patient, such as denied insurance or other benefits.
For more information on complex care, visit www.gpscbc.ca.
—Keith J. White, MD
Chair, Patterns of Practice Committee
This article is the opinion of the Patterns of Practice Committee and has not been peer reviewed by the BCMJ Editorial Board. For further information contact Juanita Grant, audit and billing advisor, Physician and External Affairs, at 604 638-2829 or firstname.lastname@example.org.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org