Enhancing Palliative Care Services to Benefit Both You and Your Patient
Palliative care services help support patients and families who have reached the palliative stage of a life-limiting disease or illness, with a life expectancy of up to six months, and who consent to the focus of care being palliative. Along with the challenges of providing the best care for patients, physicians also have to deal with understanding the complexity of palliative care MSP billing codes. We have prepared some quick tips to help you more efficiently and effectively bill for palliative care services.
General guidelines for palliative care billing.
There are a few general guidelines to be aware of when billing for palliative care services:
- To bill for palliative care, the patient must be diagnosed with:
- Malignant disease or AIDS
- End-stage respiratory, cardiac, liver and renal disease
- End-stage dementia with life expectancy of up to 6 months
- Fee codes can be billed when there is no aggressive treatment of the underlying disease process and care is directed to maintaining the comfort of the patient until death occurs.
- Fee codes are not limited to patients who are in a palliative care unit but are also available for patients who are in acute care hospitals, hospice facilities, or other institutions.
- Fee codes are invalid if the patient dies from an illness they were not hospitalized for.
- All palliative care fee codes can be billed continuously once the patient is given a palliative status, for a period not to exceed 180 days prior to death. If you submit palliative care claims that go beyond 180 days, you need to leave a note in the MSP note field explaining why. MSP will then consider your reasons and either approve or reject it.
Palliative care MSP billing codes: What to bill and when
To optimize your billing, you will need to know what the MSP billing codes are and when to bill them. Here are the five most common codes used for billing palliative care services:
| Code | Description | Amount to bill |
|---|---|---|
| 00127 – Terminal Care Facility Visit | The 00127 fee item accounts for any terminal care facility visit to a palliative care patient. | $53.87 |
| 13338 – Community Based GP: First Facility Visit of the Day Bonus | The bonus fee item is billed for the first facility visit of the day. This fee item is paid only if 13008, 13028, and 00127 is paid the same day. Regardless of the number of facilities attended, there is a limit of one payable for the same physician, same day. | $49.72 |
| 13228 – Community Based GP: Hospital Visit (courtesy/associate privileges) | The hospital visit code is for physicians who are not the primary palliative care physicians. This is payable once per calendar week per patient up to the first four weeks. Thereafter, payable once per two weeks up to a maximum of 90 days. For visits over 90 days, an explanation in the note record is required. | $30 |
| 13005 – Advice About a Patient in Community Care | Fee item 13005 is claimed for advice by telephone, fax, or in written form about a patient in community care in response to an enquiry initiated by an allied health care worker specifically assigned to the care of the patient. This fee may be billed to a maximum of one per patient per physician per day. | $18.22 |
| PG14063 – FP Palliative Care Planning Fee (Effective April 1, 2020) | The FP Palliative Care Planning Fee is payable only to family physicians who have successfully submitted and met the requirements of the PG14070 or PG14071 in the same calendar year. It is payable once per patient once the patient is deemed to be palliative. The code is only eligible if the patients are living at home or in assisted living and they are not in acute and long term facilities. | $100 |
We can help simplify the complexity of palliative care codes and provide resources to help physicians bill efficiently and realize as much as $200 per palliative patient from missed billing opportunities.
Want more support in billing palliative care fee codes? Download our Quick Reference Guide or reach out to one of our experts.
