Billing for CDM in British Columbia

In British Columbia, the General Practice Services Committee (GPSC) compensates family physicians for the additional work, beyond the office visit, of providing guideline informed care for certain chronic conditions. Family physicians who manage patients with chronic diseases can receive additional yearly payments, in addition to what they receive for regular patient visits. You can claim payment following a year of patient chronic disease management (CDM), provided that you also develop a disease-specific care plan for the patient.

Tip: For complete information on the GPSC Chronic Disease Management Incentive program in BC, go to: www.gpscbc.ca/family-practice-incentive/chronic-disease-management.

The following table summarizes the chronic diseases eligible for incentive billing, and the associated billing codes:

Chronic disease	Code	Code if visits were provided while working under salary, service contract, or sessional arrangement
Diabetes	14050	14250
Heart failure	14051	14251
Hypertension	14052	14252
COPD	14053	14253

Patient eligibility for CDM incentive billing

To bill a patient for an incentive code, the patient must have been billed for at least two visits in the past 12 months, only one of which can be a Telephone visit (14076) or a Group Medical Visit (13763-13781).

You can bill only once per diagnosis, per patient, per year.

You cannot bill for 14052 (hypertension), if you have billed 14050 (diabetes mellitus) or 14051 (heart failure) in the preceding year. This is because management of hypertension is included in the guideline for diabetes and heart failure management.

Visits provided by a locum for a GP are included; however, an electronic note indicating this must be submitted with the claim.

Patients must be insured by MSP. CDM incentive payments are not available to patients from out-of-province.

Patients in long-term care facilities are eligible.

Patients are no longer eligible as soon as the Palliative Planning Incentive (14063) has been billed.

When a GP assumes the practice of another GP who has been providing care to patients with eligible chronic conditions, the CDM fees are billable on fee anniversary dates provided the new GP has continued to provide care to these patients.

Managing CDM billing in Wolf EMR

Using Wolf EMR practice searches, you can manage your CDM incentive billing:

On a daily basis, use rules to prompt you to bill for patients who are due for their annual CDM billing. See Viewing and managing patient rule matches.

Using the eligibility criteria set by the GPSC, you can create and activate rules that flag patients who are due for their annual CDM billing. See Creating practice search rules.

Wolf EMR includes pre-configured rules that flag patients who are due for CDM incentive billing. In the list of practice searches, they start with “CDM”, such as “CDM DM Billing Incomplete”.

Note: You may have to modify the parameters in the pre-configured rules for your clinic’s workflow.

Tip:

Using rules to manage CDM billing

If a group of billing staff manage CDM billing, create a “Billing” or “CDM billing” security group for these staff members. Then, when you create a CDM billing rule, assign “Billing” as the role for the rule. When the billing staff view the clinic’s rule matches, they can filter the list to display only rule matches assigned to “Billing”. See Creating security groups.

When you view your rule matches, you can bill a patient directly from the rule matches window. Click the patient’s name, and then press <Ctrl><Shift><$>.

On a less regular basis, use search reports to summarize patients who are due for their annual CDM billing.

Tip: When you view your rule matches, you can bill a patient directly from the rule matches window. Click the patient’s name, and then press <Ctrl><Shift><$>. The EMR opens the billing window for the patient.