Providing important palliative care is good for your patients and can lead to a $5,000 bonus.
Palliative care is a service that provides specialized medical care to patients that are experiencing a serious illness. The primary physician in charge of the palliative care patient is required to develop a comprehensive care plan for the last year of life expectancy for the patient. With the focus on caring for the patient, it is often difficult for doctors to also spend time trying to understand and manage their billings. In response to these challenges, we have put together a summary of the palliative care codes in order to make the billing process easier and to help physicians save time in figuring out how to bill the codes to maximize their revenue.
The major palliative care codes that we see at DoctorCare being billed often by primary care physicians include:
- K023 – Palliative Care Support (>20min)
This time-based K code is recommended for a palliative care support service provided in the office or at home. If at home, there are rules and additional codes you need to bill (based on time and day). Please remember to document start and stop times.
- G511 – Telephone Management of Palliative Care
This is the telephone support code you can bill if you provide palliative care support over the phone to the patient or family.
- G512 – Palliative Care Case Management Fee
This is the case management code you can bill when you provide supervision of palliative care to the patient for a period of one week, starting at midnight on Sunday.
- B966 – Palliative Home Visit – Travel Premium
This code is billed for travelling to a palliative care patient’s home for a visit. This code can be billed as many times as needed.
- B997/B998 – Palliative Home Visit – First Person Seen
This code is only applied for the first person seen on that day during the home visit. This code can be billed as many times as needed.
Palliative Care Home Visits
Note, for home visits, you likely will be billing three codes for that one home visit (K023/A900 + B966 + B997/B998). As a best practice, we recommend billing the K023 when you spend more than 20 minutes providing palliative care to a patient. The A900 (complex house call assessment) may be billed on patients that are frail and elderly or housebound when the palliative care visit is under 20 minutes.
Additional Related Codes
Other codes that you may bill for providing services relevant to palliative care include the following home care codes:
- K070 for home care application
- K071 for acute home care supervision (first 8 weeks)
- K072 for chronic home care supervision (after 8th week)
- K015 for counselling of relatives
Special Premium Bonus
There is also a special premium bonus for providing palliative care services. In the fiscal year, if you bill K023, C882, A945, C945, W882, W872, B997 and B998 on any patient (rostered or non rostered), it will count for the palliative care special premium bonus.
- Ontario Medical Association (OMA) has excellent resources on palliative care that contains even more codes for case conferences, special consultations, etc.
- Download our Quick Reference Guide for a quick one-page reference on palliative care codes.
- Request a complimentary FHO special premiums use analysis from us and see how you can maximize your billings.
Need assistance in billing your palliative care codes? We’re happy to help.