Some physicians report significant delays or denial of payment for their Initial Expedited Comprehensive Consultations (19911). According to recent data from WorkSafeBC, a top reason for this is missing or illegible consult reports.

When your 19911 is submitted to WorkSafeBC, the system automatically searches for proof of a consult report. If the system is unable to find such a report, the 19911 is reviewed manually by WorkSafeBC, which may result in payment delays. If WorkSafeBC is unable to find the appropriate consult report, it may result in a payment rejection.

When to bill a 19911 fee

The Initial Expedited Comprehensive Consultation (19911) fee may be billed when:

• The physician has received a new referral for consultation from a referring physician or from WorkSafeBC (on behalf of the referring community physician), including when the consultation occurs as a result of an emergency.
• More than 6 months have lapsed since the physician last saw the injured worker and the physician has received a new referral.

The Initial Expedited Comprehensive Consultation report must be received by WorkSafeBC within 15 business days from the referral.

Details on billing Initial Expedited Comprehensive Consultations can be found in the Physicians and Surgeons’ WorkSafeBC Services Reference Guide at www.worksafebc.com/en/health-care-providers/provider-types/physicians.

Please note that physicians with a Royal College specialty, apart from anesthesiologists, should bill fee code 19911. Anesthesiologists should use fee code 19934 for the initial expedited consult, and family physicians with areas of expertise (e.g., sports medicine, diving medicine, addictions medicine, family practice anesthesia) should use fee code 19945.

Billing 19911 tips

• A new WorkSafeBC Physician Consult Report Fax Cover Sheet (Form 83D556) can be found on WorkSafeBC’s website to fax with your consult report to WorkSafeBC at 1 888 922-8807. Physicians can use this cover sheet to submit their consult reports—this is voluntary and is meant to help physicians reduce their related payment rejections and delays.
  • The new fax cover sheet tags and identifies your report for easier payment.
  • The consult report should be sent as soon as possible and must be sent before your billing for 19911.
  • Clearly document the worker’s claim number on all pages of your report.
• If you choose not to use the new fax cover sheet:
  • Clearly note “Consult Report” and the worker’s claim number on your fax cover sheet.
  • The consult report should be sent as soon as possible and must be sent before your billing for 19911.
  • Clearly document the worker’s claim number on all pages of your report.
• Ensure your documentation is legible; typed reports are recommended.
• Consult reports must be comprehensive and must be documented in keeping with professional standards (according to the College of Physicians and Surgeons of British Columbia’s practice standard on medical records documentation).
• Label your consult reports, and fax them separately from OR reports.
• Ensure any consult report transcribed by the hospital has been faxed to WorkSafeBC at 1 888 922-8807.
• While a claim is pending acceptance by WorkSafeBC, physicians do not need to wait for approval from WorkSafeBC to expedite the initial consult.
  • Please see the patient as soon as possible to ensure the consultation and report are completed and received by WorkSafeBC within 15 business days to meet timelines for payment.
  • However, for pending claims, subsequent visits beyond the initial consultation may not be covered by WorkSafeBC.
  • Please obtain the claim number from the worker or from the referring physician and mark it on your consult report and fax cover sheet.

If you have any questions, contact Doctors of BC at worksafebc@doctorsofbc.ca.
—Patrick Wong
Quality Assurance Supervisor, WorkSafeBC
—Dana Chmelnitsky
Program Manager, WorkSafeBC
—Farnaz Ferdowsi
Senior Analyst, Doctors of BC

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This article is the opinion of WorkSafeBC and has not been peer reviewed by the BCMJ Editorial Board.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.