PSP Child and Youth Mental Health
Learning Session 3
© 2012 British Columbia Medical Association and Dr. Stanley P. Kutcher. Health educators and
health providers are permitted to use this publication for non-commercial educational purposes
only. No part of this publication may be modified, adapted, used for commercial or non-educational
purposes without the express written consent of the BCMA and Dr. Kutcher.
www.pspbc.ca
Objectives
 By the end of this session, you will be able to:
› Share at least one idea from another practice that you want
to try
› Explain how you can maximize your billing for CYMH
Services
› Describe the next steps in collaborating with services in your
community
› Describe ways to collaborate with local school boards
› Identify 1-3 actions you will take to increase the likelihood
your changes will be sustained
2
A mind that is stretched by a new experience
can never go back to its old dimensions.
-Oliver Wendell Holmes, Jr.
3
Sharing our experiences




What have you tried in the last action period
What has gone well? (bring data!)
What has not gone well?
What can help to move this work forward?
4
Storyboard Template
Our Team
Our team aim statement:
Our team members (photo encouraged)
6
Our Results so far
Insert numeric data, include run charts on key measures for the
module.
7
Changes Tested or Implemented
8
Other changes we couldn’t resist testing
9
From all this testing, we have learned
10
We are surprised by
11
Next, we wonder if we should
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Reflections
 What is one idea that you want to try?
 What is one thing you still have questions about?
13
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Billing
Child/Youth Mental Health Billing
Family Physicians
 MSP
› Counseling (00120)
 Maximum 4 services per year per patient – not restricted to patient’s own FP
 Minimum 20 minutes, see preamble definition/requirements – Effective July 1,
2015 require start and end times both in chart and fee submitted.
› Office Visit (00100)
 For follow-up that does not meet Pre-amble requirements of counseling (time
&/or nature of visit)
› Group Medical Visits (13763 [3 pts] – 13781 [> 20 pts])
 Sliding scale based on number of patients billed per patient
 Billed per ½ hour or greater portion to max of 3 units per patient (1.5 hr max)
 Removes individual face-to-face “service” requirement
 Not included in HVLIP cap calculations
15
Child/Youth Mental Health Billing
Family Physicians (continued)
 MSP – Non-face-to-face services
› Telehealth Service with Direct Interactive Video Link with Patient


In Office – FP has equipment at office to provide service
o
P13037 Telehealth GP in-office Visit
o
P13038 Telehealth GP in-office Individual counselling (minimum time per visit – 20 minutes – up to 4 per
calendar year)
o
P13041 – Group counseling of 2 or more patients first hour, P13042 2nd hour per ½ hr or greater portion – bill
only on one patient
Out-of-Office – FP must go to HA facility to access equipment to provide service
o
P13017 Telehealth GP in-office Visit
o
P13018 Telehealth GP in-office Individual counselling (minimum time per visit – 20 minutes – up to 4 per
calendar year)
o
13021 – Group counseling of 2 or more patients first hour, 13022 2nd hour per ½ hr or greater portion – bill
only on one patient
› Advice about Patient “In Community Care” (13005)


“Community Care” comprises Residential, Intermediate and Extended care and includes patients
receiving home Nursing care, Home Support or Palliative Care at Home.
For phone/fax advice requested by Allied Health Care worker specifically assigned to the care of
the patient. Allied Care workers are defined as: Home care coordinators, nurses (registered,
licenses practical, public health and psychiatric), psychologists, mental health workers,
physiotherapists, occupational therapists, respiratory therapists, social workers, ambulance
paramedics and pharmacists (not intended for Rx renewal).
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Child/Youth Mental Health Billing
Family Physicians
 GPSC – fees restricted to FP accepting role of MRP for longitudinal
coordinated care of patient for that calendar year
› Mental Health Planning Fee (G14043)




Axis 1 diagnoses only
30 minutes face to face planning visit
If longer may also bill 00100 or 00120 depending on time and nature of service (+
00100 if up to 49 min; or + 00120 if 50 min or more and fulfills counseling preamble
requirements)
As of July 1, 2015 must state start and end times of the total service (planning plus
any additional visit/counselling in chart and when submitting fees to MSP.
› Mental Health Management (G14044 – Counseling Equivalent)



Maximum 4 services per year per patient once four 00120 used up – restricted to
patient’s FP who billed G14043
Same preamble requirements as 00120
As of July 1, 2015 must include start and end times when submitting face-to-face
time based fees, and this must also be documented in the patient chart
› Patient Telephone/e-mail Follow-up fees (G14079)
› Attachment Patient Telephone Fee (G14076)
 if FP is participating in Attachment – available 1500 per FP per calendar
year and billable for any patient in practice – use G14076 if all 5 X G14079
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billed in calendar year
Child/Youth Mental Health Billing (continued)

GPSC – Conferencing Fees – restricted to FP accepting role of MRP for longitudinal
coordinated care of patient for that calendar year
› Attachment Patient Conferencing Fee (G14077)
 Replaces G14015/16/17 for FPs participating in Attachment (submitted G14070 same
calendar year)
 per 15 min or greater portion, max 2 units per day, 18 units per calendar year in any
clinical/patient setting.
 Conferencing by phone or in person with at least 1 allied health professional
› Community Patient Conferencing Fee (G14016)



Only billed by FSFP not participating in Attachment
per 15 min or greater portion, max 2 units per day, 6 units per calendar year for any patient living
in community.
Conferencing by phone or in person with at least 1 allied health professional
› Urgent Telephone Advice from a Specialist or GP with Specialty Training Fee
(G14018) – call within 2 hours due to patient acuity

Telephone Advice Fees – Specialists (SSC – G1000X codes); GPs with Specialty Training
(GPSC – G1402X codes)
› G10001/G14021 – response within 2 hours
› G10002/G14022 – response within 1 week
› G10003/G14023 – telephone follow-up with patient
› GPSC definition GPs with Specialty Training GPs who has specialty training and who
provides services in that specialty area through a health authority supported or approved18
program.
CYMH Workbook Case – Anna

You are Anna’s FP and school counselor
has contacted you about concerns resulting
in visit to see her in your office.

Visit #1 – 20 minute counseling visit – Dx
probable Depression 311 (00120 #1)

Visit #2 – 30 minute mental health planning
visit – Dx 311 (14043 as you are her FP)

Visit #3 – e-mail follow up 3 days later
(14079 #1)

Visit #4 – 25 minute counseling visit Dx 311
(0120 #2)
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CYMH Workbook Case – Anna (continued)
 25 minute telephone conferencing with school counselor – Dx 311 (14077 or
14016 X 2 units)
 Visit #5 – 20 minute counseling Dx 311 (0120 #3 – error in booklet – listed as
counseling #4)
 After this, telephone conferencing with school counselor and mental health
clinician totaling 30 minutes (14077 or 14016 X 2 units – total 4 units now
billed)
 Followed by 3 regular office visit follow ups (3 X 00100)
 Visit #9 – 25 minute counseling Dx 311 (00120 #4)
 Visit #10 – regular office visit
 Visit #11 – 25 min counseling Dx 311 (first GPSC counseling equivalent 14044)
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Collaborating with School Boards
 to be developed in local areas
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Improving Local Systems of Care
for CYMH patients
Improving Local Systems of Dare
 Insert description…
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What is our local system?
Step 1:
 Who is in your local System of care for CYMH patients
› Clinical Services – community based and specialty services
› Educational services
› Support services/support groups
› Patient groups
› Patients and their families
 Allocate 1 group to each box
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What is our local system?
Step 2:
 What is the role of each of these groups?
› List primary purpose of organization
› Any inclusions/exclusion criteria
 Add description where prompted
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What is our local system?
Step 3:
 What are the natural connection points between each group
› Connect groups who have existing, active connections
› Put a few words describing the connection
GP
Referral request
Specialist
Consult letter
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What is our local system?
Step 4
 What are connections that need to be developed between these
services
› Insert a dashed arrow between the groups
› Add a few words describing the new connection
GP
Referral
???
MCFD
Clinicians
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What is our local system?
Step 5
 List the actions required to test the new connections in your local
systems
› Identify who needs to be involved
› Who will do what
› When will you test this
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Are there any new connections that
you would like to test?
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Sustaining Your Gains
Why focus on sustainability?

Up to 70% of change initiatives fail, impacting:
› Best possible care
› Staff and provider
frustration
› Reluctance to engage in future
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You’ve had a head start!
The involvement of families and community members in your
improvement work will help you sustain
› More partners in care
› Recognition and encouragement from team mates
› Maximizing community and family support
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You can all work as one to sustain changes in
practice and community!
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What are you trying to sustain?
With your community team discuss what you would like to sustain
in the practice and community, is it:
› A specific change?
› A measured outcome from your efforts?
› An underlying culture of improvement?
› Relationships established in the community?
› A combination?
› (5 min)
Source: NHS Improvement leader’s Guide: Sustainability, NHS Institute for Innovation and
Improvement, 2007
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Strategies to Sustain the Changes
 Be clear about the benefits (use measurement)
 Establish and document standard processes and have a plan for
ongoing training
 Establish an ongoing measurement processes
 Make changes to job descriptions and procedures to reflect
change
 Celebrate success!
Adapted from: NHS Improvement leader’s Guide: Sustainability, NHS Institute for Innovation and
Improvement, 2007
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Predictors of Sustainability
 Staff, providers and patients can describe why they like the
change and it’s impact
 Providers and staff are confident and can assist in explaining to
others
 Job descriptions reflect new roles
 Measurement is part of the practice and used to monitor
progress
 The change is no longer ‘new’, but ‘the way we do things around
here’
Adapted from: NHS Improvement leader’s Guide: Sustainability, NHS Institute for Innovation and
Improvement, 2007
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Sustainability Activity
 At your table, develop a plan for increasing the probability of
sustaining your improvement work
 Use one or more of the strategies outlined in the previous slide,
or come up with others
 Share your ideas with the group
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Thank you!