By: Lorne Verhulst, MD
Physicians billing with subspecialty designations
Issue: BCMJ,
vol. 59, No. 10, December 2017,
Page 501 Billing Tips
Audits have revealed that physicians who have subspecialty designations may be billing consults out of one section of the payment schedule, and subsequent office/hospital visits (and other services) out of another section for the same patient.
Section C.16 of the General Preamble of the MSC Payment Schedule states:
A specialist recognized in more than one specialty by the College of Physicians and Surgeons of British Columbia should bill consultation and referred items under the specialty most appropriate for the condition being diagnosed and/or treated for that referral/treatment period.
If you have dual specialities, keep in mind that:
• At each visit, it is important to identify which specialty/subspecialty is most relevant to the patient’s chief complaint or the main issue being discussed.
• In most cases, for an individual patient, consultations and subsequent office/hospital visits should be billed under the same specialty/subspecialty since all of these services are usually related to the same condition.
• You should bill the fee item most relevant to the service being delivered.
• You should not bill the higher value fee item unless it is justified.
Always refer to the MSC Payment Schedule (or the Doctors of BC Guide to Fees) and its Preamble for interpretation of all fees.
—Lorne Verhulst, MD
Chair, Patterns of Practice Committee
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This article is the opinion of the Patterns of Practice Committee and has not been peer reviewed by the BCMJ Editorial Board.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, manager, audit and billing, Physician and External Affairs, at 604 638-2829 or jgrant@doctorsofbc.ca.