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Doctors of BC and WorkSafeBC
Physician Reference Guide
A Companion Document to the Agreement Between the
Workers’ Compensation Board (WorkSafeBC) and the
Doctors of British Columbia (BC Medical Association)
Department
Health Care Services
Date
April 01, 2014 to March 31, 2019
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Contents
INTRODUCTION ............................................................................................................................. 3
DOCTORS OF BC/WORKSAFEBC CONTRACT ....................................................................................... 4
Background ................................................................................................................................ 4
Important Information on Prescribing Medication ............................................................................. 4
Community Physician Services for Complex Spinal Cord Injury .......................................................... 4
Fee Code 19509 – Complex Spinal Cord Injury Initial Visit or Yearly Assessment .............................. 4
Fee Code 19510 – Complex Spinal Cord Injury Office Visit ............................................................. 4
Fee Code 19511 – Complex Spinal Cord Injury Home Visit ............................................................. 4
Specialist Services ....................................................................................................................... 5
Expedited Consultations............................................................................................................. 5
Expedited Surgery .................................................................................................................... 6
Surgical Assistants .................................................................................................................... 7
Expedited Anaesthesia Services .................................................................................................. 8
Expedited Surgery Billing Procedure ............................................................................................ 8
BILLING WORKSAFEBC ................................................................................................................... 9
Facts about Timeliness and Electronic Submission............................................................................ 9
Physician Report Form Completion & Submission ........................................................................... 10
PHYSICIAN FORM 8/11 REFERENCE GUIDE ...................................................................................... 11
Injury Coding ............................................................................................................................ 14
APPENDICES FOR PHYSICIAN REFERENCE GUIDE ............................................................................. 15
Appendix A – CSA Body Codes for WorkSafeBC Reporting & Invoicing Purposes. Side of Body Codes ... 16
Appendix B – CSA Body Codes for WorkSafeBC Reporting & Invoicing Purposes. Body Part Codes (CSA
Z795). ..................................................................................................................................... 17
Appendix C – Explanatory Codes for Teleplan Rejections ................................................................ 19
Appendix D – Application for Compensation and Report of Injury or Occupational Disease (Form 6) ..... 21
Appendix E –Physician’s Report (Form 8/11) ................................................................................. 24
Appendix F – How to Complete the Form 8/11: Physician’s Report Form ........................................... 26
Appendix G – Surgical Procedures List .......................................................................................... 27
Appendix H – Physician’s Invoice (Form 11A) ................................................................................ 30
Appendix I - Authorization Request for Surgery (83D6) .................................................................. 31
Appendix J - Invoice for Expedited Anaesthesia (83D10) ................................................................ 32
Appendix K – Summary Invoice for Extensive Spine Surgical Assist ................................................. 33
Appendix L - Requisition for Medical Imaging (83D56).................................................................... 34
Appendix M - Summary Invoice for Extensive Spine Surgery (83D8) ................................................ 36
Appendix N - Contact Information ................................................................................................ 37
Appendix O - Summary Fee Schedule with Rate Changes and Effective Dates ................................... 40
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Physician Services Reference Manual
This manual is intended to assist with specific business processes related to doing business with the
Workers’ Compensation Board of BC (WorkSafeBC). This is not a stand-alone document and it is intended
that this manual be used in conjunction with the Physician Services Memorandum of Agreement and all the
related Schedules. Please ensure that all staff has access to and understand the content of this manual.
INTRODUCTION
The Workers’ Compensation Board of British Columbia is providing this Reference Guide to assist you with
understanding the Agreement between the Workers’ Compensation Board (WorkSafeBC) and the Doctors
of British Columbia (BC Medical Association) and for reporting to and invoicing to WorkSafeBC.
By law, the Workers’ Compensation Board can only pay for medical services related to an accepted
WorkSafeBC claim. That means that the patient’s injury or illness must be determined by WorkSafeBC to
be a direct result of a work-related activity or occupational disease to qualify for WorkSafeBC benefits.
This adjudicative process may depend on non-medical issues such as employment status and is not solely
based on medical evidence.
Working with Physicians and Employers in this province, WorkSafeBC’s goal is to facilitate a safe, timely,
and durable return to work for injured workers. To this end a number of WorkSafeBC unique fees relate to
expedited clinical services with reimbursement reflecting timely services and electronic submission of
reports and invoices, as well as return to work services.
Payment for WorkSafeBC approved services for fee for service and unique WorkSafeBC fees is provided by
electronic funds transfer via HIBC (MSP) Teleplan. Transaction details are provided on Teleplan remittance
statements. Please contact HIBC directly at (604) 456-6950 or toll free at 1 866 456-6950 to set up
Teleplan billing and electronic fund transfer.
Most of the routine medical services such as regular office visit (MSP fee code 00100) are billed to
WorkSafeBC using the MSP fee code.
An uplift will be applied automatically on all MSP fee codes (not WorkSafeBC unique fee codes and form
fees) invoiced to WorkSafeBC. The uplift is 10% if invoicing electronically via Teleplan, or 3% if invoice is
submitted by fax to WorkSafeBC.
The WorkSafeBC unique fee-for-service fee codes referred to in the Agreement between the Doctors of BC
and WorkSafeBC do not have an uplift applied. These fees are negotiated directly between the Doctors of
BC and WorkSafeBC.
A Note on the Word “Claim”
When a person suffers a work-related injury or contracts a work-related disease, he or she can make a
claim for compensation to WorkSafeBC.
To WorkSafeBC, that claim represents a relationship between the injured worker & WorkSafeBC that lasts
for weeks, months or even years.
However, in an MSP billing context, a claim is a submission of a new invoice.
Please note that throughout this document, the word claim refers to the ongoing relationship between an
injured worker and WorkSafeBC, not to new invoices.
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DOCTORS OF BC/WORKSAFEBC CONTRACT
Background
The current Agreement between Doctors of BC and WorkSafeBC is a term from April 01, 2014 to March
31, 2019.
Information provided in this section:
Discusses the changes in the Doctors of BC/WorkSafeBC Agreement, outlines the business processes and
indicates the dates that new rates are to be applied.
Provides fee changes and effective dates for Form & Unique Fees and Expedited Service Fees (see
Appendices K & L for Schedules B and D which are excerpts from the Agreement).
A summary fee schedule with rate changes and effective dates is also provided in Appendix O.
Important Information on Prescribing Medication
Generic substitution medication is mandatory; write “No Sub” for patients requiring brand name
medication.
Community Physician Services for Complex Spinal Cord Injury
Three fee codes specifically address the unique circumstances that are inherent in caring for an injured
worker with a Spinal Cord Injury with Permanent Sequelae.
These fees recognize the additional time required to provide services to this population and to
acknowledge the complexity of this type of injury.
Fee Code 19509 – Complex Spinal Cord Injury Initial Visit or Yearly Assessment
• Initial or Annual Assessment (yearly thereafter) to include a complete physical exam
• Develop and update a yearly care plan documented on a Form 8/11
A template to assist in developing and documenting the care plan is available on the WorkSafeBC website:
https://www.worksafebc.com/en/resources/health-care-providers/guides/spinal-cord-injury-patient-careflow-sheet
Fee Code 19509 may be billed once per year.
• Form 8/11 outlining a care plan will be paid in addition to Fee Code 19509; there is no additional
fee for the Spinal Cord Injury Patient Care Flow Sheet document above.
Fee Code 19510 – Complex Spinal Cord Injury Office Visit
• Can be billed for all other office visits occurring during the year
• Report on a Form 8/11; Form 8/11 will be paid in addition to Fee Code 19510
• Cannot bill in addition to an Initial Visit or Yearly Assessment Fee Code 19509.
Fee Code 19511 – Complex Spinal Cord Injury Home Visit
• Perform a home visit
• Report on a Form 8/11; Form 8/11 will be paid in addition to Fee Code 19511.
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•
If the home visit is the Initial Visit or the Yearly Assessment then bill both Fee Codes 19511 and
19509 but cannot be billed with Office Visit (Fee Code 19510).
Specialist Services
Expedited Consultations
Expedited Comprehensive Consultations
Referrals for Initial and Repeat Expedited Comprehensive Consultations can be made to a Specialist
Physician by WorkSafeBC or a referring physician. Non-Specialist Physicians with Areas of Expertise (e.g.
Sports Medicine) must be approved by WorkSafeBC to provide Initial Expedited Comprehensive
Consultations. Once approved for the Initial Expedited Consultation, the Repeat Consultations do not
require approval.
The fees include the physical examination and report. No other office visit or report fees may be billed in
addition.
Standards for reporting for an expedited comprehensive consultation shall contain the following core
information:
• Purpose of examination
• Nature of injury
• Present complaints
• Objective findings
• Diagnosis or differential diagnosis
• Information regarding causation including risk factors other than work; and
• Recommendations regarding work restrictions as related to the work injury/disease.
(It is not possible to provide a specific diagnosis in every case. It may, however, be possible to
exclude serious or progressive conditions that may be worsened by work.)
Specialist Physicians and Physicians with Areas of Expertise are entitled to the Expedited Comprehensive
Consultation fee if the following criteria are met:
•
Reporting Timeliness Criteria:
• The Initial Expedited Comprehensive Consultation report must be received by WorkSafeBC
within fifteen (15) business days from the referral. If after the Initial Expedited Consultation, a
referral is made for a Repeat Expedited Consultation, the report must be received within fifteen
(15) business days of the referral.
• For any other Consultations (e.g. Repeat Consultation scheduled by the consulting physician
versus being referred): the report must be received within five (5) business days of the
consultations.
• Where following a consultation the consulting physician concludes the Worker is fit to return to
work, this information must be received by WorkSafeBC within three (3) days of the
consultation.
Initial Expedited Comprehensive Consultation (Fee Code 19911):
• The Physician is entitled to the Initial Expedited Comprehensive Consultation fee for the first
consultation on each claim. A new Initial Expedited Comprehensive Consultation may occur if:
• more than six (6) months lapsed since the physician last saw the Worker; and
• the consultation is as a result of a new referral.
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Repeat Expedited Comprehensive Consultation (Fee Code 19912):
• The Physician is entitled to the Repeat Expedited Comprehensive Consultation fee for one (1)
repeat consultation when the repeat consultation occurs within twelve (12) weeks of the first
Consultation following the referral. Any other repeat consultation is not entitled to expedited fees.
• In the case of a post-operative consultation, that follow up visit and report are to be invoiced as the
post-operative consultation service as described in Fee Schedule B, using fee code 19931. The
post-operative consultation is not considered a Repeat Expedited Comprehensive Consultation.
• If the expedited time frames outlined above for submission of the report are exceeded, then bill the
appropriate MSP specialty consultation fee code. If applicable, bill a Non-Expedited specialist
consultation report, initial or repeat (fee code 19908), for consultation services that do not include
a report in the MSP fee item description. Report must be received by WorkSafeBC within seven (7)
business days following date of service or following request by WorkSafeBC.
Expedited Surgery
Expedited Surgical Services Timeline
The surgeon must submit an Authorization Request for Surgery. Please refer to Form 83D6 found in
Appendix I of this Reference Guide.
The Authorization Request for Surgery (Form 83D6) must be submitted to WorkSafeBC within five (5)
business days following the Consultation Report that includes the surgeon’s recommendation for surgery.
NOTE: authorization for surgery does not equate to payment of expedited rates for surgery. Expedited
rates will be paid if the surgery meets the eligibility criteria indicated herein.
In the case of emergency (trauma) surgery performed, the prescribed Authorization for Surgery Form
(Form 83D6 – Authorization Request for Surgery) is submitted within five (5) business days following the
emergency (trauma) surgery to the Claims Officer for entitlement approval, along with the comprehensive
consultation report. Upon entitlement approval and receipt of the comprehensive consultation report, the
expedited surgery fee will be paid.
All elective procedures must be performed within forty (40) business days from the date of the last
consultation. The one exception is Expedited Extensive Spine Surgery (see below).
Where it is not possible to schedule a surgery within the forty (40) business days, the surgeon may seek
approval from Health Care Services to extend the time frame in order to ensure that the surgery will be
performed on an expedited basis and will be billable as such, if approved. Otherwise, for procedures
performed after forty (40) business days, WorkSafeBC Expedited Surgery rates will not apply.
The operative report must be received within twenty (20) business days of the date of surgery, and is a
requirement for WorkSafeBC to process payment.
NOTE: If requirements are met, a premium uplift on the fees is paid. If not met, the regular MSP fees will
be paid.
Only the first three (3) elective surgeries per patient will be considered for expedited payment per each
surgeon. This applies only to repeat surgeries performed on the same site. Any subsequent surgical
consideration for additional surgery requires a second opinion by a Richmond VSC Specialist and further
surgery will require authorization from the Health Care Services Program Manager.
Expedited payment may be extended beyond the first three elective procedures for multiple non-emergent
reconstructive procedures (both surgical and anesthesia services) when the following process occurs:
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•
•
•
A letter is submitted providing early identification of the complexity by outlining the patient details,
volume and proposed procedures, and timeline to completion;
A Surgical Authorization form is directed to the Claims Officer for entitlement approval; and
A letter is directed to the Health Care Services Program Manager for payment approval and system
activation.
Extensive Spine Surgery
These sessional rate fees are designed for surgeons performing difficult and extensive spinal procedures
requiring stabilization or multilevel procedures or revisions discectomy (one level index discectomy is not
meant to be covered by these fees). Pre-approval by WorkSafeBC is required.
The 40-business day requirement in Article 3.3.3 of the WorkSafeBC-Doctors of BC Agreement are waived
for these services.
Billing – Expedited Surgery
All expedited surgical procedures (with the exception of extensive spinal surgery) must be billed
electronically through HIBC Teleplan:
• Bill the applicable MSP Surgical Procedure Fee Codes
• Apply WorkSafeBC Out-of-Office Hours Surcharge using one of the following fee codes as
applicable:
• 19320: Expedited Surgical Procedure Surcharge, Operative Evening
• 19321: Expedited Surgical Procedure Surcharge, Operative Night
• 19322: Expedited Surgical Procedure Surcharge, Operative Sat/Sun/Holidays
• Apply MSP Out-of-Office Premiums – Call Out Charges, Continuing Care Surcharges – Operative, as
applicable
• Fax the operative report to (604) 233-9777 or Toll Free at 1 888 922-8807
Extensive spinal surgery must be billed on paper by completing the Summary Invoice for Extensive Spine
Surgery (form 83D8) and fax to (604) 244-6292 or toll free 1-877-279-7590 along with the operative
report.
Refer to the chart on page 9 for an example of application of the Expedited Surgery billing process.
Surgical Assistants
Procedures recognized as qualifying for Surgical Assistants performed in private surgical facilities have
been identified, and the Surgical Assist Procedures list is posted on the Health Care Practitioners and
Providers page in WorkSafeBC.com website (Physicians - Medical and Surgical Specialists):
http://www.worksafebc.com/health_care_providers/health_care_practitioners/medical_and_surgical_speci
alists/default.asp.
The current list is included in Appendix N. If a procedure is not listed, the Physician must contact the
Program Manager, Health Care Services at WorkSafeBC for approval prior to the surgery. The list will be
reviewed from time to time by the WorkSafeBC/Doctors of BC Liaison Committee. This list does not apply
to surgeries performed in hospitals.
Extensive Spine Surgery Assist
These sessional rate fees are designed for surgical assistants performing difficult and extensive spinal
procedures requiring stabilization or multilevel procedures or revisions discectomy (one level index
discectomy is not meant to be covered by these fees). No additional fee codes or surcharges are billable
in addition to the sessional fee code.
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Billing – Expedited Surgical Assist
All expedited surgical procedures (with the exception of extensive spinal surgery assist) must be billed
electronically through HIBC Teleplan:
• Include only one applicable MSP Surgical Assist Fee Code
• Apply MSP Out of Office Premiums – Call Out Charges Continuing Care Surcharges – Operative, as
applicable
• Plus one of the appropriate time based unique WorkSafeBC Fee Code: Fee Codes 19545 to 19552
(Levels 1-7)
• Apply WorkSafeBC Out of Office Premiums using one of the following fee codes as applicable:
• 19410: Expedited Surgical Procedure Surcharge, Operative Evening
• 19411: Expedited Surgical Procedure Surcharge, Operative Night
• 19412: Expedited Surgical Procedure Surcharge, Operative Sat/Sun/Holidays
Extensive spinal surgical assist must be billed on paper by completing the Summary Invoice for Extensive
Spine Surgical Assist (form 83D9) and fax to (604) 244-6292 or toll free 1-877-279-7590.
Refer to the chart on page 9 for an example of application of the Expedited Surgery Assist billing process.
Expedited Anaesthesia Services
Billing – Expedited Anaesthesia Surgical Services
• Anaesthesia services for all expedited surgical procedures (with the exception of nerve block
injections and extensive spinal surgery) must be billed electronically through HIBC Teleplan using:
• the appropriate MSP Fee Code (Intensity & Complexity Index), and
• WorkSafeBC Unique Fee Code 19507 – Expedited Anesthesia Services (time based fee code per
15 minute time block)
• Apply MSP and WorkSafeBC Out-of-Office Surcharges as applicable.
• The anaesthetic time includes a pre-operative assessment, as well as the time from induction until
the anaesthesiologist is no longer in attendance and the injured worker can be safely discharged for
the post-anesthetic recovery (PAR). If the pre-operative and PAR times are significantly longer than
fifteen (15) minutes, respectively, or a total of thirty (30) minutes, then an explanatory note shall
accompany the record of anesthesia.
• A copy of the Record of Anesthesia must be faxed to (604) 233-9777 or Toll Free at 1 888 9228807. Be sure to include the Claim Number on the Record of Anesthesia.
• Expedited extensive spine anaesthesia sessional fee must be billed on paper by completing the
Expedited Surgery Summary Invoice for Anesthesia (Form 83D10) and fax along with the Record of
Anaesthesia to (604) 244-6292 or toll free at 1-877-279-7590. Be sure to include the Claim
Number on the Record of Anesthesia.
Refer to the chart on page 9 for an example of application of the Expedited Anaesthesia billing process.
Expedited Surgery Billing Procedure
Billing Procedure Example
•
•
•
8
Surgery: Fractured Tibia- Open Reduction & Internal Fixation (ORIF)
Time: Tuesday 0125-0425 hours
Surgery duration: three (3) hours
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Expedited Surgical Billing Process:
Surgeon Billing
MSP Fee code- ORIF
MSP Out-of-Office Surcharge(s)
Fee Code
56755
Apply as required
Process
Bill through Teleplan
Bill through Teleplan
WorkSafeBC Out-of-Office Hours
Surcharge
Apply as required
Bill through Teleplan
Anaesthesiologist Billing
MSP Level 3 for time of 3.5 hours
Fee Code
01173
Process
Bill through Teleplan
WorkSafeBC Unique FeeAnaesthesia Time Based Block for
time of 3.5 hours
MSP Out-of-Office Surcharge(s)
19507
Bill through Teleplan
Apply as required
Bill through Teleplan
WorkSafeBC Out-of-Office Surcharge
Apply as required
Bill through Teleplan
Surgical Assist Billing
MSP Surgical Assists fee code
WorkSafeBC Unique Expedited
Surgical Assist – Level 4
MSP Out-of-Office Surcharge(s)
Fee Code
00197
19548
Process
Bill through Teleplan
Bill through Teleplan
Apply as required
Bill through Teleplan
WorkSafeBC Out of Office Surcharge
Apply as required
Bill through Teleplan
BILLING WORKSAFEBC
WorkSafeBC has an agreement with HIBC Teleplan:
• To enable physicians to electronically submit invoices and Form 8/11 Physician’s Report to
WorkSafeBC. Submission of Form 8/11 by fax will result in reduced payments. Physicians will not
be paid for invoices for Form 8/11 submitted to WorkSafeBC via mail service, courier service or any
like service.
• To issue payments through electronic funds transfer (EFT). Reimbursement is made to physicians
for WorkSafeBC related services, using either MSP fee codes and or WorkSafeBC Forms Fees and
Unique fee codes.
Facts about Timeliness and Electronic Submission
Form 8/11 Physician’s Report Submission
Only one (the first) Form 8 received for a claim will be paid as a Form 8. The date the Form 8 is received
is the determining factor for payment.
Any subsequent Form 8 received by WorkSafeBC for the initial visit will be paid at the appropriate Form 11
(Progress Report) rate.
Form 8/11 shall be submitted electronically through HIBC Teleplan within three (3) business days of the
date of service. A penalty will be applied for Form 8/11 submitted electronically when received between
four (4) and six (6) business days of the date of service. No payment for Form 8/11 submissions received
after six (6) business days. The Office Visit will be paid.
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A higher payment rate will be paid for the submission of a Form 8/11 received through HIBC Teleplan than
via fax to WorkSafeBC.
Following entry of Form 8/11 information into your Form 8/11 software package, please ensure that you
SUBMIT each report to HIBC Teleplan immediately. Entry into Teleplan’s system is completed only when
you click SUBMIT.
Payments and remittance statements are provided bi-weekly.
Electronic Invoice Submission
Background:
Software designed for submission through Teleplan must be used. Software information/installation for
electronic submission of reports and invoices can be obtained from Software Vendors. Software vendor
information can be obtained by contacting www.msva.ca or calling 1-800-663-2094 (Medical Software
Vendors Association). After installation of software follow the instructions provided by the Software Vendor
for billing.
Invoices must be submitted electronically through HIBC Teleplan, unless otherwise specified. If invoices
are submitted to WorkSafeBC via fax, WorkSafeBC will submit the invoice electronically to HIBC Teleplan
on your behalf through our Paper Invoice Processing System (PIPS). This may result in service charges
and delayed payments. For submission via fax, please use Form 11A unless otherwise specified. See
Appendix O for a sample of Form 11A. It can also be obtained from the WorkSafeBC website:
http://www.worksafebc.com/forms/assets/PDF/11a.pdf. Because Teleplan is an automatic system, the
information you provide must be correct and consistent before the system will allow payment for your
services. The date of service, payee number and fee item submitted must exactly match the date of
service, payee number and fee item on the invoice transmitted to WorkSafeBC. If they do not match, your
invoice will be rejected and you will need to correct the differences and resubmit the invoice.
Since Workers usually have a WorkSafeBC claim number within two weeks of initial treatment, physicians
can help WorkSafeBC match an invoice with a valid WorkSafeBC patient claim by adding the claim number
to billings. Not providing the claim number will delay processing of payment.
Physicians must bill WorkSafeBC within ninety (90) days of providing service.
A remittance statement returned to you following an invoice submission may include the explanatory code
“BK”. A “BK” explanatory code means that WorkSafeBC has received the submission and is currently
making a decision on the injured worker’s claim. Some complex claims can take more than sixty (60) days
to make an entitlement decision, so patience is appreciated. Do not re-bill because payment has not been
received. When a decision has been reached payment will be made or a rejection code will be provided
indicating why payment will not be made. The status of a Worker’s claim can be checked using the online
tool here: http://www.worksafebc.com/claims/managing_claims/view_claims/default.asp. Three pieces of
information are required: your payee number, the Worker’s claim number, the Worker’s personal health
number (PHN).
If you receive a refusal code of “AA”, the Worker does not have a PHN or is not a resident of BC. Resubmit
the invoice via fax to WorkSafeBC. Indicate on the invoice that a PHN is not available.
Physician Report Form Completion & Submission
Physician Report Forms
Physicians will report using the combined Form 8/11 for either the first report or a progress report. A first
report must be filed to establish an injury claim with WorkSafeBC. Critical Information for Completing the
Physician Report - Form 8/11:
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•
Form 8 – Physician’s First Report
• Should be submitted only if the doctor suspects time loss beyond the day of the injury or if the
claim is for a hernia, back problem, shoulder/knee strain or sprain, mental disorder, or
occupational disease.
•
Form 11 – Physician’s Progress Report
A Form 11 should be submitted as a progress note, if:
• There is a change in medical condition;
• There is a change to the Worker’s treatment plan;
• There is a change in Return to Work status;
• It has been more than 4 weeks since the last Form 11 was sent, or
• A Form 11 is requested by a WorkSafeBC Officer.
Clinical Information reporting – This area provides space for clinical reporting. The Addendum page to
Form 8/11 is used when more reporting space is required than is available in the clinical information area
on Form 8/11.
IMPORTANT: Electronic submission of a Form 8 and a Form 11 is the best way to send your reports.
However, there is a limitation on the length of the free text in three boxes on the form. The Clinical
Information section of the report Form 8/11 is presently limited to 800 characters of text and
punctuation. The Prior or Other Problems section of the report is limited to 160 characters. The
Current Restrictions section is limited to 240 characters. Please use a new electronic form each
time you submit a report. If you exceed the number of characters limitation in any of the sections noted
above, please submit the second part of your report as another Form 8/11 using billing fee code 19943 for
a Form 8, and using billing fee code 19944 for a Form 11. Any text after the characters limitation will
not be received by WorkSafeBC.
Form 8 reports submitted through Teleplan are billed with fee code 19937. All Form 11 reports submitted
through Teleplan are billed with fee code 19940.
Return to Work Planning – Return-to-work planning is an important reporting component of Form 8/11.
The information the physician provides, along with physician participation in the return-to work
consultation process assists WorkSafeBC in handling each Worker’s claim efficiently and appropriately.
A Requested First Report (Requested Form 8) should be submitted only when a Physician’s First Report
(F8) was not originally required and has subsequently been requested by WorkSafeBC (usually via a fax or
phone call from a WorkSafeBC officer). Invoice fee code 19927 through Teleplan.
Detailed instructions for completing the Form 8/11 can be found in the next section.
PHYSICIAN FORM 8/11 REFERENCE GUIDE
Please use this reference guide when completing Physician’s reports.
Form 8/11 – Physician’s Report
Form Field Name
Physician’s First Report
(F8)
11
Description
Selecting this field indicates the report is a Physician's
First Report (Form 8). It should be submitted to
WorkSafeBC if the Physician thinks there may be time
loss beyond the day of the injury or if the claim is for a
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or The Worker’s condition or
treatment has changed
(F11)
Employer's name
Operating location address
and Mailing address
WorkSafeBC claim number
Worker’s last name
First name
Worker’s contact telephone
number
Worker’s PHN from health
card
Date of injury
Date of service
Who rendered the first
treatment?
Are you the Worker’s regular
practitioner?
If “Yes”, how long has the
Worker been your patient?
hernia, back problem, shoulder/knee strain or sprain,
occupational disease, or mental disorder.
Selecting this field indicates the report is a Physician's
Progress Report (Form 11) and should be submitted if the
Worker's condition or treatment has changed since last
report or if the Worker is ready for Return to Work. A
report is not necessary or desired if the Worker's
condition is stable and there will be a planned follow up at
an appropriate future date. A report is also not necessary
if the Worker is enrolled in a WorkSafeBC-sponsored
rehabilitation program. Payment of benefits to a Worker is
not contingent on follow-up every two weeks if the above
conditions are met.
The full corporate or company name of the Worker’s
employer.
The address or description of where the Worker was
employed on the day of the injury. For example the
branch address, campsite location or administrative office.
This includes the address information and city.
WorkSafeBC claim number specific to this injury. Do not
include the two-letter claim prefix if there is one.
The Worker’s legal last name or surname. It should match
the surname on the Worker’s British Columbia CareCard.
The Worker’s full first or given name. Initials or
abbreviated names should not be used. It should match
the given name on the Worker’s British Columbia
CareCard.
A contact area code and telephone number for the
Worker. Usually this would be the Worker’s home phone
number, but could be a cellular number or work number.
Worker’s Personal Health Number as shown on the British
Columbia CareCard.
The date when the WorkSafeBC related injury occurred.
In the case of occupational diseases, this is the date when
medical attention was first sought.
The date when the physician’s service described on this
report was performed.
Medical practitioner (name) or facility (emergency
department, clinic, hospital, etc.) who provided the first
treatment. This does not include first aid at the worksite.
If “Yes”, WorkSafeBC may contact you for medical history
or to discuss claims issues.
Select the duration for which the Worker has been your
patient. This information is useful for claims information.
Form 8/11
12
Form Field Name
Description
Prior/Other Problems
affecting injury, recovery
and disability
This is a free text field of up to 160 characters (text,
spaces, and punctuation) maximum to provide details
about pre-existing or new non-occupational conditions that
may affect injury, recovery or disability. If insufficient
Physician Services Reference Guide
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Diagnosis:
CSA BP (code):
CSA AP (code):
CSA NOI (code):
ICD9 (code)
From injury or since last
report, has the Worker been
disabled from work?
If Yes, as of what date? (if
known)
Clinical Information
Is the Worker now
medically capable of
working full duties, full
time?
13
space, add remaining information to “Clinical Information”
box. For example the Worker sustained an MVA while
receiving care for the WorkSafeBC claim.
Provide a text description of the injury diagnosis.
This is a 5-character (numeric) code for the area of injury
(body part) from the WorkSafeBC subset of CSA codes
(80/80 list). Full set of codes available at:
http://www.worksafebc.com/health_care_providers/Assets
/PDF/body_parts_complete.pdf
This is a code for the anatomical position code (side) of the
injury from the WorkSafeBC subset of CSA codes (80/80
list).
Left
L
Right
R
Left and Right
B
Not applicable
N
Use this for body systems, a
major body part such as skin,
heart or stomach, or
multiple/other parts.
This is the 5-character (numeric) code for the nature of
injury from the WorkSafeBC subset of CSA codes (80/80
list). Full set of codes available at:
http://www.worksafebc.com/health_care_providers/Assets
/PDF/nature_injury_complete.pdf
This is the ICD9 diagnosis code and is also entered on the
invoice (claim record). Full set of codes available at:
http://www2.gov.bc.ca/gov/content/health/practitionerprofessional-resources/msp/physicians/diagnostic-codedescriptions-icd-9
If the Worker has been disabled from work since the injury
or the last report, select “Yes”. Otherwise, select “No”.
If known, enter date when Worker was first disabled from
the work place in the format yyyy/mm/dd.
This is a free form text field of up to 800 characters
(text, spaces, and punctuation) for the physician to
describe the Worker’s current situation in the usual fashion
clinical notes are constructed. The following information
might be included:
• What happened
• Presented injury, disease, complaints and etc.
• Subjective symptoms
• Examination finding
• Treatments and medications being used
• The name and date of specialist referral, if
appropriate.
Indicate “Yes” if the Worker has no medical restrictions
and can return to their normal pre-injury duties. If “No”,
elaborate in the “restrictions” area below. This is a free
Physician Services Reference Guide
May 2018
What are the current
physical and/or
psychological restrictions?
Estimated time before the
Worker will be able to
return to the workplace in
any capacity.
If appropriate, is the
Worker now ready for a
rehabilitation program?
If “Yes”, select Work
Conditioning Program or
Other
If possible, please estimate
date of Maximal Medical
Recovery
Payee Number
Practitioner Number
text field of up to 240 characters (text, spaces, and
punctuation) maximum.
Describe the physical and/or psychological restrictions
related to the injury that you impose as barriers to the
patient returning to work. This information will be used by
the case managers and medical advisors in working with
employers to find suitable alternative/modified work.
Estimate the length of time before the Worker can return
to the workplace in ANY capacity. For example, the earliest
possible return to the workplace if suitable duties were
available.
Enter “No” if Worker is not ready for a rehabilitation
program or if a rehabilitation program is not appropriate. If
“Yes”, select WCP (Work Conditioning Program) or indicate
the type of rehabilitation program in the following field.
If ”Other rehabilitation program” is selected, indicate type
of program (for example, occupational rehabilitation
program, pain program, etc.) by including this
recommendation in the “Clinical Information” area above
in the report.
Maximal medical recovery (full recovery or best possible
recovery) date. This is sometimes also called date of
“maximal medical improvement”. It refers to the date at
which no further improvement in condition is expected. At
that time the Worker may still have significant
impairment/disability or may be fully recovered. It is
recognized that the "date" indicated is an estimate only
and may change if the clinical course changes.
Enter the payee number issued by MSP that uniquely
identifies the individual or organization who submits the
associated invoice to WorkSafeBC and who will be paid by
WorkSafeBC.
Enter the practitioner number issued by MSP that uniquely
identifies the Physician who performed the service and
provided the information for this report.
Injury Coding
WorkSafeBC has adopted the Canadian Worker’s Compensation Board injury coding standards (Version
2).These codes are mandatory fields on all Form 8/11 Physician’s Reports and invoices submitted through
HIBC Teleplan either by the Physician’s office or WorkSafeBC’s PIPS system.
Injury coding consists of three components:
• Side of body or AP (Appendix A)
• Body part or BP (Appendix B)
• Nature of injury or NOI (Appendix C)
These codes are a key element for case management and early intervention. They also assist in the
matching of invoices to claims, which results in more timely payment.
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APPENDICES FOR PHYSICIAN REFERENCE GUIDE
A Companion Document to the Agreement Between the Workers’ Compensation Board (WorkSafeBC) and
the Doctors of British Columbia (BC Medical Association)
April 01, 2014 – March 31, 2019
Appendices have been provided for your convenience.
A - CSA Side of Body Codes for WorkSafeBC Reporting & Invoicing Purposes. Side of body codes
B - CSA Body Part Codes for WorkSafeBC Reporting & Invoicing Purposes. Body part codes (CSA Z795)
C - Explanatory Codes for Teleplan Rejections
D – Application for Compensation and Report of Injury or Occupational Disease (Form 6)
E – Physician’s Report (Form 8/11)
F – How to Fill Out Form 8/11: Physician’s Report Form
G – Surgical Procedures List
H – Physician’s Invoice (Form 11A)
I – Authorization Request for Surgery (Form 83D6)
J – Invoice for Expedited Anaesthesia (Form 83D10)
K – Invoice for Expedited Extensive Spine Surgical Assist (Form 83D9)
L – Requisition for Medical Imaging (Form 83D56)
M - Summary Invoice for Extensive Spine Surgery
N – Contact Information
O – Summary Fee Schedule with Rate Changes and Effective Dates
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Appendix A – CSA Body Codes for WorkSafeBC Reporting &
Invoicing Purposes. Side of Body Codes
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Appendix B – CSA Body Codes for WorkSafeBC Reporting &
Invoicing Purposes. Body Part Codes (CSA Z795).
Below is a Quick Reference Guide, for the complete list please go to:
http://www.worksafebc.com/health_care_providers/Assets/PDF/body_parts_complete.pdf
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Appendix B – CSA Body Codes for WorkSafeBC Reporting &
Invoicing Purposes. Body Part Codes (CSA Z795) Continued.
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Appendix C – Explanatory Codes for Teleplan Rejections
The list is available online at:
http://www.worksafebc.com/health_care_providers/Assets/PDF/explanationcodes.pdf
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Appendix D – Application for Compensation and Report of Injury or
Occupational Disease (Form 6)
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Appendix E –Physician’s Report (Form 8/11)
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Appendix F – How to Complete the Form 8/11: Physician’s Report
Form
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Appendix G – Surgical Procedures List
This list is available online at:
http://www.worksafebc.com/health_care_providers/Assets/PDF/Surgical_procedures_list.pdf
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Appendix H – Physician’s Invoice (Form 11A)
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Appendix I - Authorization Request for Surgery (83D6)
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Appendix J - Invoice for Expedited Anaesthesia (83D10)
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Appendix K – Summary Invoice for Extensive Spine Surgical Assist
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Appendix L - Requisition for Medical Imaging (83D56)
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Appendix M - Summary Invoice for Extensive Spine Surgery (83D8)
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Appendix N - Contact Information
WorkSafeBC Contact Information:
1. WorkSafeBC Online Information (www.WorkSafeBC.com).
Visit www.WorkSafeBC.com for additional information regarding:
•
•
•
•
•
Resources such as brochures and post-surgical rehabilitation guidelines
Injury coding tables
Instructions for billing & reporting
Contact information
Links to related sites
2. Payment Services
Billing Inquiries or Billing Assistance (including Paper Invoice Processing System - PIPS)
Phone: (604) 276-3085 or
Phone Toll free: 1-888-422-2228
Operations Manager
Payment Services, Physician Inquiries
Direct line (604) 232-5808
Mailing Address
Payment Services
WorkSafeBC
P.O. Box 94460 Stn Main
Richmond, BC V6X 8V6
3. Medical Services Inquiries (Medical Administration)
Medical Administration General Inquiries (604) 244-6224
Manager of Medical Services (604) 232-5825
4. Visiting Specialist Clinic – Specialist Consultations/Diagnostic Imaging Bookings/Inquiries
Phone: (604) 214-6700
Toll free phone: 1-888-967-5377
Fax: (604) 214-6799
5. Clinical/Management Matters call:
Program Manager
Health Care Services: (604) 232-7787
Films Distribution
Phone: (604) 276-3066
Fax: (604) 231-8890
Email: [email protected]
6. Medical Imaging Expedited Referral Request
Complete Form 83D56 ‘Requisition for Medical Imaging’ & fax to 604-233-9777 or toll free at 1-888922-8807.
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7. Call Centre (Claim/Claimant Inquiries)
(604) 231-8888 or 1-888-967-5377
8. Ordering WorkSafeBC Forms:
www.WorkSafeBCstore.com
Toll free phone: 1-866-319-9704
Toll free fax: 1-888-232-9174
Email: [email protected]
Store hours: Mon – Fri 8:30am – 4:30pm
You may download copies of forms and brochures from WorkSafeBC.com website at the following
address: www.WorkSafeBC.com. Select “forms” or “publications”
9. For non-MSP billing inquiries, please contact Purchasing Services at 604-276-3344 or toll free 1-844276-3344.
10. Mailing Information
WorkSafeBC
PO Box 5350 Stn Terminal
Vancouver BC V6B 5L5
External Contact Information:
1. Contact HIBC (MSP) Teleplan for Billing Support/Teleplan transmission problems
Vancouver: (604) 456-6950
Other areas of B.C. (toll-free): 1 866 456-6950
For any status, address or licensure updates, Physicians should contact the College of Physicians and
Surgeons of BC and MSP.
2. Medical Software Vendors (provide software for electronic submission to HIBC Teleplan)
www.msva.ca
1 800 663-2094 (Software Vendor Association)
3. Workers’ Advisory Office - Patient Resource:
Physicians can advise injured workers that they can obtain free claim advice or assistance from the
Workers’ Advisory Office (independent of WorkSafeBC).
Website: www.labour.gov.bc.ca
Contact phone numbers:
Vancouver/Lower Mainland
Richmond
Phone: (604) 713-0360
Toll free phone: 1 800 663-4261
Fax: (604) 713-0311
Island
Campbell River
Phone: (250) 830-6526
Toll free phone: 1 800 661-4066
Fax: (250) 830-6528
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Nanaimo
Phone: (250) 741-5504
Toll free phone: 1 800 661-4066
Fax: (250) 741-5516
Victoria
Phone: (250) 952-4393
Toll free phone: 1 800 661-4066
Fax: (250) 952-4399
Interior
Kelowna
Phone: (250) 717-2096
Toll free phone: 1 800 663-6695 881-1188
Fax: (250) 717-2010
Kamloops
Phone: (250) 371-3860
Toll free phone: 1 800 663-6695
Fax: (250) 371-3820
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Appendix O - Summary Fee Schedule with Rate Changes and Effective Dates
This fee schedule includes fees for: Form fees, WorkSafeBC Unique Fees.
1.0
FORM FEES
Fee
Code
Description
Form 8 - Report of First Injury,
received by WorkSafeBC within
three (3) business days of date of
service and transmitted
electronically.
19937
If Form 8 is received by
WorkSafeBC within four (4) to six
(6) business days of the date of
service and transmitted
electronically, then a reduced fee
is paid.
Effective
Apr 1, 2014
Effective*
Jul 23, 2015
Effective
Apr 1, 2016
$50.96
$51.96
$52.61
$35.61
$35.97
$36.67
$37.13
$33.96
$34.30
NA
$34.73
$50.46
Effective
Apr 1, 2015
Effective
Apr 1, 2017
Effective
Apr 1, 2018
$54.20
Bill in
addition to
office visit
$37.69
$38.25
Bill in
addition to
office visit
$35.25
$35.78
Bill in
addition to
office visit.
$23.85
Bill in
addition to
office visit.
$53.40
If Form 8 is received seven (7)
business days or later following
the date of service, the fee paid is
$0.
Form 8 - Report of First Injury,
received by WorkSafeBC within
three (3) business days of date of
service and submitted via fax
transmission.
19900
If Form 8 is received by
WorkSafeBC within four (4) to six
(6) business days of the date of
service and submitted via fax
transmission, then a reduced fee
is paid.
$22.64
$22.87
NA
If Form 8 is received seven (7)
business days or later following
the date of service, the fee paid is
$0.
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$23.15
Comments
$23.50
Fee
Code
19927
Description
First Report of Injury (Form 8)
that is requested by WorkSafeBC
after the injured worker is seen
where the form is not initially
required (See Form 8 Rules),
received within ten (10) business
days of the faxed or telephone
request.
Effective
Apr 1, 2014
Effective
Apr 1, 2015
Effective*
Jul 23, 2015
Effective
Apr 1, 2016
Effective
Apr 1, 2017
Effective
Apr 1, 2018
$56.61
$57.18
NA
$57.89
$58.76
$59.64
Bill in
addition to
office visit.
$41.46
$41.87
$42.37
$42.90
$43.55
$44.20
Bill in
addition to
office visit
$18.82
$19.01
$19.24
$19.48
$19.77
$20.07
Bill in
addition to
office visit
Submissions received after ten
(10) business days of request will
not be paid. Fee Code 19904 may
not be billed in addition as this
fee includes copying of any
existing reports or chart notes
from an injured worker’s file.
Form 11 - Progress Report
Physical Examination, received
within three (3) business days of
date of service by WorkSafeBC
and transmitted electronically.
19940
If Form 11 is received by
WorkSafeBC within four (4) to six
(6) business days of the date of
service and transmitted
electronically, then a reduced fee
is paid.
If Form 11 is received seven (7)
business days or later following
the date of service, the fee paid is
$0.
* Date of ratification for Doctors of BC
41
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Fee
Code
Description
Form 11 - Progress Report
Physical Examination, received
within three (3) business days of
date of service by WorkSafeBC
and submitted via fax
transmission.
19902
If Form 11 is received by
WorkSafeBC within four (4) to six
(6) business days of the date of
service and submitted via fax
transmission, then a reduced fee
is paid.
Effective
Apr 1, 2014
Effective
Apr 1, 2015
Effective*
Jul 23, 2015
Effective
Apr 1, 2016
Effective
Apr 1, 2018
Comments
$30.55
$30.86
NA
$31.25
$31.72
$32.20
Bill in
addition to
office visit.
$15.27
$15.42
NA
$15.62
$15.85
$16.09
Bill in
addition to
office visit.
If Form 11 is received seven (7)
business days or later following
the date of service, the fee paid is
$0.
* Date of ratification for Doctors of BC
42
Effective
Apr 1, 2017
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2.0
WORKSAFEBC UNIQUE FEES
Fee
Code
Description
Effective
Apr 1, 2014
Effective
Apr 1, 2015
Effective
Apr 1, 2016
Effective
Apr 1, 2017
Effective
Apr 1, 2018
19904
WorkSafeBC request for copy of a consultation, operative,
chart notes or other existing report – first twenty pages,
received within three (3) business days of request. Not to be
paid in addition to other Fee Codes except Fee Code 19906.
$41.99
$42.41
$42.94
$43.58
$44.23
19905
WorkSafeBC requested copy of consultation, operative, or
other existing report – first five (5) pages or less sent by
mail.
$26.24
$26.50
$26.83
$27.23
$27.64
19919
Office Consultation with a WorkSafeBC Officer or designate
(up to fifteen (15) minutes)
$58.79
$59.38
$60.12
$61.02
$61.94
19906
Continuation of Fee Code 19904 – over twenty (20) pages
additional per page.
$1.26
$1.27
$1.29
$1.31
$1.33
19907
A factual written summary or reasoned medical opinion upon
written request from WorkSafeBC (19904 may not be billed
in addition). If extractions included over five (5) pages –
may bill Fee Code 19906.
$267.70
$270.38
$273.76
$277.87
$282.04
$52.49
$53.01
$53.67
$54.48
$55.30
19930
Telephone consultation with WorkSafeBC Claims
Adjudicator/Case Manager or designate or allied health care
provider* in fifteen (15)-minute increments (not to be billed
for routine inquiries) up to a maximum of forty-five (45)
minutes (i.e. to a daily maximum of three (3) units) per
claim.
*Community allied health care providers include providers
involved in the care of an injured worker, such as
physiotherapist, occupational therapist, psychologist,
WorkSafeBC-sponsored treatment program physician or
other program staff. 1
1
Change to allied health care providers will be effective date of ratification July 23, 2015
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Fee
Code
00129
Description
Emergency call-out when a Physician (General Practice or
Specialist) has to immediately leave his or her home or
office (outside of hospital) to attend an injured worker. This
fee is billed over and above medical service fees.
19942
WorkSafeBC Job-site meeting
19922
Materials used in conjunction with sterile tray fees. Bill the
actual cost of materials.
19908
Non-expedited specialist consultation report, initial or
repeat, for consultation services that do not include a report
in the fee item description. Report must be received by
WorkSafeBC within seven (7) business days following date
of service or following request by WorkSafeBC.
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Effective
Apr 1, 2014
Effective
Apr 1, 2015
Effective
Apr 1, 2016
Effective
Apr 1, 2017
Effective
Apr 1, 2018
$70.53
$71.24
$72.13
$73.21
$74.31
$309.69
$312.79
$316.70
$321.45
$326.27
Actual Cost
Actual Cost
Actual Cost
Actual Cost
Actual Cost
$28.34
$28.62
$28.98
$29.41
$29.85
May 2018
Fee
Code
Description
Effective
Apr 1, 2014
Effective
Apr 1,
2015
Effective*
Jul 23, 2015
$136.47
$137.83
$170.59
Effective
Apr 1, 2016
Effective
Apr 1, 2017
Effective
Apr 1, 2018
$172.72
$175.31
$177.94
EXCESSIVELY PROLONGED OR COMPLEX
CASES
19929
Excessively prolonged or complex cases. At the
request of WorkSafeBC, a Physician will review the
file(s), examine the injured worker, and develop a
report on an injured worker whose recovery is
prolonged or complicated. The Parties agree that,
unless it is not practical, such cases should be
referred to the WorkSafeBC medical rehabilitation
program for appropriate review, assessment and
case planning.
In situations where WorkSafeBC requires
information about a Worker who is not under active
treatment but who continues to have an injury
claim, WorkSafeBC may request a Physician, who
had treated the Worker, to review the file(s) and
develop a report describing the details of the injury,
diagnosis, and treatment.
Report must be received within twenty (20)
business days of service. Submissions received
after twenty (20) business days will not be paid.
* Date of ratification for Doctors of BC
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Fee
Code
Description
Effective
Apr 1, 2014
Effective
Apr 1, 2015
Effective
Apr 1, 2016
Effective
Apr 1, 2017
Effective
Apr 1, 2018
$78.73
$79.52
$80.51
$81.72
$82.95
POST OPERATIVE CONSULTATION
19931
In recognition of WorkSafeBC‘s need to have surgeons
involved in disability management, WorkSafeBC agrees to
pay a post-operative visit and a Form 11 or a consultation
report fee for a total value as indicated on the right to
assess a Worker’s potential to return to work on a graduated
or full time basis; or to refer the Worker to the appropriate
treatment program in the WorkSafeBC continuum of care; or
if neither are appropriate, to recommend a treatment plan
with an estimate of recovery and return to work.
This WorkSafeBC unique service would occur within the
forty-two (42) day post-operative period, usually at four (4)
weeks post-surgery.
Report must be received within five (5) business days of
service. Submissions received after five (5) business days
will not be paid.
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Fee
Code
Description
Effective
Apr 1, 2014
Effective
Apr 1, 2015
$272.95
$275.68
$21.00
$21.21
Effective*
Jul 23, 2015
Effective
Apr 1, 2016
Effective
Apr 1, 2017
Effective
Apr 1, 2018
$ 300.24
$303.99
$308.55
$313.18
NA
$21.48
$21.80
$22.13
RETURN TO WORK CONSULTATION
Purpose is to facilitate a safe, early return to
work. Can be initiated by WorkSafeBC Officer
or delegate, WorkSafeBC Physician, employer
or by treating Physician.
19950 2
Must include consultation by Physician with
employer and WorkSafeBC Officer, and follow
up to discuss RTW with Worker.
Consultation and RTW plan must be
documented and submitted on Form 11. One
further consultation cycle may be billed if
initial attempt at RTW is unsuccessful. Fee allinclusive.
* Refer to Appendix A – Memorandum of
Agreement
19952
Accounts initially rejected but found to be
WorkSafeBC responsibility. Bill directly to
WorkSafeBC by fax transmission.
* Date of ratification for Doctors of BC
2
Appendix A – Memorandum of Agreement
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Fee
Code
Effective
Apr 1, 2014
Effective
Apr 1, 2015
$125.98
$127.24
19976
Return to Work planning request. A request
initiated by a WorkSafeBC Officer or
designated rehabilitation provider to a
Physician to endorse a one (1) page Return to
Work planning request form.
$15.75
19508
Telephone consultation between a WorkSafeBC
Medical Advisor and a community Physician
which takes place within 24 hours of being
initiated by the Medical Advisor
$74.54
Description
Effective*
Jul 23, 2015
Effective
Apr 1, 2016
Effective
Apr 1, 2017
Effective
Apr 1, 2018
NA
$128.83
$130.76
$132.72
$15.91
$25.00
$25.31
$25.69
$26.08
$75.29
NA
$76.23
$77.37
$78.53
WorkSafeBC Request For Existing Report
or Chart Notes - ISOLATING SPECIFIC
INFORMATION
19953
When WorkSafeBC requests a copy of an
existing report or chart notes and where
complying with that request requires the
Physician to review the chart or report for the
purpose of severing identified personal
information not relevant to the claim prior to
submission of photocopied material, or
identifying previous injury or illness relevant to
the current claim, or area of injury in question
from prior records and separating that
information from other clinical information
prior to submission to WorkSafeBC.
The Physician may bill Fee Code 19953. Fee
Codes 19904, 19905 or 19906 may not be
billed in addition to this Fee Code.
Must be received within ten (10) business days
of request of service and includes all courier
charges.
* Date of ratification for Doctors of BC
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Fee
Code
Description
Effective
Apr 1, 2014
Effective
Apr 1, 2015
19509
Complex Spinal Cord Injury initial visit or
yearly assessment. Visit to include a complete
physical exam and updated care plan
documented and presented on a form 8/11.
Only payable once per patient per year, by
noted regular physician. Form 8/11 will be
paid in addition.
$154.38
$155.92
19510
Complex Spinal Cord Injury office visit, cannot
bill in addition to a yearly assessment fee (Fee
Code 19509) for one visit. Form 8/11 may be
reimbursed if changes in condition
$102.92
19511
Complex Spinal Cord injury home visit. The
physician must also complete and bill for a
Form 8/11. This fee cannot be billed with
office visit (Fee Code 19510)
$205.84
Effective*
Jul 23, 2015
Effective
Apr 1, 2016
Effective
Apr 1, 2017
Effective
Apr 1, 2018
NA
$157.87
$160.24
$162.64
$103.95
NA
$105.25
$106.83
$108.43
$207.90
NA
$210.50
$213.66
$216.86
* Date of ratification for Doctors of BC
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Fee
Code
Description
19556
Image-guided diagnostic and therapeutic injection. New
fee code to be billable only when the injection requires
imaging guidance (e.g. CT, fluoro, ultrasound) and is
arranged at a WorkSafeBC-contracted private surgical
facility, or where the physician utilizes their own imaging
equipment within their own office.
$230.54
19557
Use of physician’s own imaging equipment for imageguided diagnostic and therapeutic injection. This fee
code cannot be invoiced in addition to a surgical facility
fee code.
$135.00
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Effective
Aug 23, 2015
May 2018
Effective
April 1, 2016
Effective
April 1, 2017
Effective
April 1, 2018
$233.42
$236.92
$240.47
$136.69
$138.74
$140.82
3.0
STANDARDIZED ASSESSMENT FEE
Standard Assessment Form is to be completed by Physician only when requested by WorkSafeBC or a surgeon. This Service is to be
provided for specific assessments upon request. Standard Assessment Fee includes the physical examination and completion of the report
form. Refer to the Physicians Reference Guide for guidelines on specific reports for unique assessment types.
The Physician shall not complete a Form 11 for the examination when a Standard Assessment form is requested. The Standard
Assessment Form must be completed and received by WorkSafeBC and/or surgeon (if applicable) within fifteen (15) business days of the
request.
Fee
Code
Description
19909
19910
51
Effective
Apr 1, 2014
Effective
Apr 1, 2015
Effective
Apr 1, 2016
Effective
Apr 1, 2017
Effective Apr
1, 2018
Standardized Assessment Form received by WorkSafeBC and
surgeon (if applicable) within fifteen (15) business days of
request by WorkSafeBC
$78.73
$79.52
$80.51
$81.72
$82.94
Standardized Assessment Form received by WorkSafeBC and
surgeon (if applicable) after fifteen (15) business days of
request by WorkSafeBC
$73.49
$74.22
$75.15
$76.28
$77.42
Physician Services Reference Guide
May 2018
4.0
MEDICAL-LEGAL MATTERS
The requirements for receiving Fee Codes 19932 and 19933 are as follows:
1. Medical Legal Report is applicable to all medical Physicians.
2. Medical-Legal Opinion is applicable only to Specialists with relevant qualifications, or other Physicians with recognized expert
knowledge.
3. These fees require prior approval by the Review Board or Appeal Division, or Senior Medical Advisor or Director of the Board or Client
Service Manager.
4. These fees include examination, review of records, and other processes leading to completion of the written Opinion/Report.
Fee
Code
Description
19932
Medical-Legal Report: A report which will recite
symptoms, history and records and give diagnosis,
treatment, results and present condition. This is a factual
summary of all the information about when the injured
worker will be able to return to work and might mention
whether there will be a permanent disability.
19933
Medical-Legal Opinion: An opinion will usually include the
information contained in the Medical-Legal Report and will
differ from it primarily in the field of expert opinion. This
may be an opinion as to the course of events when these
cannot be known for sure. It can include an opinion as to
long-term consequences and possible complications in the
further development of the condition. All the known facts
will probably be mentioned, but in addition there will be the
extensive exercise of expert knowledge and judgment with
respect to those facts with a detailed prognosis.
52
Physician Services Reference Guide
Effective
Apr 1, 2014
Effective
Apr 1, 2015
Effective
Apr 1, 2016
Effective
Apr 1, 2017
Effective
Apr 1, 2018
$898.62
$907.61
$918.96
$932.74
$946.73
$1,501.21
$1516.22
$1535.17
$1558.20
$1581.57
May 2018
5.0
EXPEDITED CONSULTATIONS
Fee
Code
Description
Effective
Apr 1, 2014
Effective
Apr 1, 2015
Effective
Apr 1, 2016
Effective
Apr 1, 2017
Effective
Apr 1, 2018
19911
Initial expedited comprehensive consultation from
Specialists in Internal Medicine Neurology, Neurosurgery,
Orthopedics, Physical Medicine, General Surgery, Plastic
Surgery, Psychiatry, Urology, Otolaryngology,
Ophthalmology and Dermatology.
$347.17
$350.64
$355.02
$360.35
$365.76
19912
Repeat Expedited Comprehensive Consultation after Fee
Code 19911.
$168.68
$170.37
$172.50
$175.09
$177.72
19934
Initial expedited comprehensive consultation from an
Anesthesiologist for diagnostic opinion and/or therapeutic
management. To include a physical examination and a
written report. If followed by a diagnostic or therapeutic
nerve block, the consultation may be charged in addition to
the nerve block fees on the first occasion.
$347.17
$350.64
$355.02
$360.35
$365.76
19935
Repeat Expedited Comprehensive Consultation after Fee
Code 19934.
$168.68
$170.37
$172.50
$175.09
$177.72
19945
Initial expedited comprehensive consultation from a
Physician With Areas of Expertise, only when requested by
WorkSafeBC.
$277.47
$280.24
$283.74
$288.00
$292.32
19946
Repeat Expedited Comprehensive Consultation after Fee
Code 19945.
$134.94
$136.29
$137.99
$140.06
$142.16
53
Physician Services Reference Guide
May 2018
6.0
EXPEDITED SESSIONAL SERVICES
Fee Code
Description
Effective
Apr 1, 2014
Effective
Apr 1, 2015
Effective
Apr 1, 2016
Effective
Apr 1, 2017
Effective
Apr 1, 2018
Comments
1150464
Initial Expedited Consultation Service Fees /
Sessional Rate (VSC ONLY)
$2,107.82
$2128.90
$2155.51
$2187.84
$2220.66
Bill as per
contract
1150465
Repeat Expedited Consultation Service Fees /
Sessional Rate (VSC ONLY)
$2,107.82
$2128.90
$2155.51
$2187.84
$2220.66
Bill as per
contract
19519
Expedited Sessional Interventional Pain
management Services under personal services
agreement.
$1,613.80
$1629.94
$1650.31
$1675.06
$1700.19
Bill as per
contract
54
Physician Services Reference Guide
May 2018
7.0
EXPEDITED SURGERY OUT-OF-OFFICE HOURS SURCHARGES BILLABLE BY SURGEONS
Fee Code
Description
19320
Expedited Surgery, Out of Office Hours
Surcharge, Operative Evening (18:00 to
23:00 hours)
19321
Expedited Surgery, Out of Office Hours
Surcharge, Operative Night (23:00 to 08:00)
19322
Expedited Surgery, Out of Office Hours
Surcharge, Operative Sat/Sun/Holidays
55
Physician Services Reference Guide
Effective
Nov 1, 2015
Effective
Apr 1, 2016
Effective
Apr 1, 2017
Effective
Apr 1, 2018
Comments
Apply this percentage, or
17.5%, or
17.5%, or
17.5%, or
17.5%, or
minimum of $65 to the paid
minimum $65 minimum $65 minimum $65 minimum $65
MSP surgery procedure fees
28%, or
minimum
$105
28%, or
minimum
$105
28%, or
minimum
$105
28%, or
minimum
$105
Apply this percentage, or
minimum of $105 to the
paid MSP surgery
procedure fees
Apply this percentage, or
17.5%, or
17.5%, or
17.5%, or
17.5%, or
minimum of $65 to the paid
minimum $65 minimum $65 minimum $65 minimum $65
MSP surgery procedure fees
May 2018
8.0
EXPEDITED ANAESTHESIA RATES FOR EXPEDITED SURGICAL PROCEDURES
Fee Code
Description
MSP Fee
Code
Expedited Anaesthesia Services:
Invoice one (1) appropriate MSP fee code
plus applicable number of units of block
billing time-based fee code 19507.
19507
Expedited Anaesthesia Time. One unit equals
15 minutes.
19518
Expedited Extensive Spine Anaesthesia –
Sessional fee (no MSP fee code applicable)
19405
19406
19407
56
Expedited Anaesthesiology, Out of Office
Surcharge, Operative Evening (6 to 11 pm) - applied to 19507
Expedited Anaesthesiology, Out of Office
Surcharge, Operative Night (11 pm to 8 am)
-- applied to 19507
Expedited Anaesthesiology, Out of Office
Surcharge, Operative Sat/Sun/Holidays -applied to 19507
Physician Services Reference Guide
Effective
Apr 1, 2014
Effective
Apr 1, 2015
Effective
Apr 1, 2016
Effective
Apr 1, 2017
Effective
Apr 1, 2018
Comments
Bill
through
Teleplan
Bill
through
Teleplan
$76.71
$77.48
$78.45
$79.62
$80.82
Per unit
Per unit
Per unit
Per unit
Per unit
$2,352.77
$2376.30
$2406.00
$2442.09
$2478.72
Bill by fax
to
WorkSafe
BC
32.77%
Bill same
number of
units as is
billed for
fee code
19507.
52.54%
Bill same
number of
units as is
billed for
fee code
19507.
32.77%
Bill same
number of
units as is
billed for
fee code
19507.
32.77%
52.54%
32.77%
32.77%
52.54%
32.77%
May 2018
32.77%
52.54%
32.77%
32.77%
52.54%
32.77%
9.0
EXPEDITED SURGICAL ASSIST RATES FOR EXPEDITED SURGICAL PROCEDURES
Fee Code
Description
Effective
Apr 1, 2014
Effective
Apr 1, 2015
Effective
Apr 1, 2016
Effective
Apr 1, 2017
Effective
Apr 1, 2018
Comments
MSP Fee
Code
Invoice one (1) appropriate MSP surgical
assist fee code related to surgical procedure,
plus applicable block billing time-based fee
code below.
19545
Expedited Surgical Assist - Level 1 (surgery
time up to 1.5 hours)
$233.63
$235.97
$238.92
$242.50
$246.14
Bill through
Teleplan
19546
Expedited Surgical Assist - Level 2 (surgery
time 1.51 to 2.0 hours)
$337.58
$340.96
$345.22
$350.40
$355.66
Bill through
Teleplan
19547
Expedited Surgical Assist - Level 3
(surgery time 2.01 to 2.5 hours)
$463.14
$467.77
$473.62
$480.72
$487.93
Bill through
Teleplan
19548
Expedited Surgical Assist - Level 4
(surgery time 2.51 to 3.0 hours)
$566.07
$571.73
$578.88
$587.56
$596.37
Bill through
Teleplan
19549
Expedited Surgical Assist - Level 5
(surgery time 3.01 to 3.5 hours)
$674.13
$680.87
$689.38
$699.72
$710.22
Bill through
Teleplan
19551
Expedited Surgical Assist - Level 6
(surgery time 3.51 to 5.99 hours)
$993.19
$1003.12
$1015.66
$1030.89
$1046.35
Bill through
Teleplan
19552
Expedited Surgical Assist - Level 7
(surgery time 6.00 hours plus)
$1,523.23
$1538.46
$1557.69
$1581.06
$1604.78
Bill through
Teleplan
19517
Expedited Extensive Spine Surgical Assist –
Sessional fee (no MSP fee code applicable
$1589.59
Bill by fax
to
WorkSafeB
C
57
Physician Services Reference Guide
Bill through
Teleplan
$1,508.82
$1523.91
May 2018
$1542.96
$1566.10
19410
19411
19412
58
Expedited Surgical Assist, Out of Office
Surcharge, Operative Evening
(6 to 11 pm)
Expedited Surgical Assist, Out of Office
Surcharge, Operative Night
(11 pm to 8 am)
Expedited Surgical Assist, Out of Office
Surcharge, Operative Sat/Sun/Holidays
Physician Services Reference Guide
32.77%
52.54%
32.77%
32.77%
52.54%
32.77%
May 2018
32.77%
52.54%
32.77%
32.77%
52.54%
32.77%
32.77%
Bill this
percentage
applied to
applicable
Level fee
code billed.
52.54%
Bill this
percentage
applied to
applicable
Level fee
code billed.
32.77%
Bill this
percentage
applied to
applicable
Level fee
code billed.
10.0
MEDICAL ADVISORS
Fee Code
Description
Effective
Apr 1, 2014
Effective
Apr 1, 2015
Effective
Apr 1, 2016
Effective
Apr 1, 2017
Effective
Apr 1, 2018
Comments
Not
applicable
Medical Advisor, sessional rate.
$532.68
per session
$538.01
$544.74
$552.91
$561.20
Billing as
instructed
Not
applicable
Specialist Medical Advisor, sessional rate.
$669.50
per session
$676.20
$684.65
$694.92
$705.34
Billing as
instructed
59
Physician Services Reference Guide
May 2018
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