3. The prescribed fee shall be accepted as payment in full for the podiatry services.

Transcription

1 WorkSafeBC Schedule for Podiatry Services 1. The Payment Schedule includes the services of podiatrists who are registered members in good standing of the College of Podiatric Surgeons of British Columbia, and licensed under the Health Professions Act, when rendered in the Province of British Columbia to WorkSafeBC-insured injured workers. 2. Surgical podiatry services must be pre-approved by the WorkSafeBC Board Officer (e.g. Case Manager). Contact the Board Officer by telephone, or written request (e.g. fax). 3. The prescribed fee shall be accepted as payment in full for the podiatry services. 4. The podiatrist will invoice WorkSafeBC only for services provided under this Payment Schedule, and will not invoice the Medical Services Plan (MSP) nor the WorkSafeBC-insured injured worker for any fee in addition to the fees set out in this Payment Schedule. 5. The surgical fee for orthopaedic procedures (fractures and dislocations) includes the postoperative follow-up period normally considered to be 90 days for such procedures. The fee for other surgical procedures includes the post-operative follow-up care, including the removal of sutures and care of the operative wound. This period is normally considered to be 42 days. 6. s for surgical procedures include anaesthesia. 7. If surgical services other than those specified are provided, or where because of serious complications or coincidental conditions additional services are required and the podiatrist wishes to claim extra remuneration, the podiatrist must describe the unusual circumstances that warranted the alternative or extra service and detail all services given provided with the podiatrist s suggested fee when submitting the podiatrist invoice to WorkSafeBC. Such claims will be subject to individual adjudication by the WorkSafeBC Health Care Services Department. Fax to Foot orthotics must be pre-authorized by WorkSafeBC Board Officer. Details on obtaining preauthorization and the billing instructions can be found at 9. All podiatry services (except foot orthotics) shall be invoiced to WorkSafeBC by fax using Generic Invoice - Medical and Health Care (form 83D128). It is available at All services must be invoiced to WorkSafeBC by fax within 90 days from the date of service. all reports and invoices to WorkSafeBC at or toll-free WorkSafeBC Payment Schedule for Podiatry Services March 1, 2019

2 Podiatry Schedule (as of March 1, (as of January 1, Visits and Reports Podiatry Visit Initial podiatry visit report Subsequent podiatry visit report Payable only if an adequate clinical record 1 has been created and maintained for the service being invoiced. Can also bill fee code or , plus or , as appropriate. Report must be received by WorkSafeBC within three (3) business days following the visit with an injured worker. Report template is found here: Can be billed in conjunction with fee code Report must be received by WorkSafeBC within three (3) business days following each visit with an injured worker, only if the injured worker s condition has changed. Report template is found here: Can be billed in conjunction with fee code $38.26 $39.41 $35.00 $36.05 $ WorkSafeBC Payment Schedule for Podiatry Services March 1, 2019

3 Complex Visit/Consultation in Hospital, Office, Institution or Injured Worker s Home Surgical consultation Non-referred preoperative assessment In-depth evaluation of a podiatric problem seen on referral of a physician requiring a comprehensive history, review of x-rays and laboratory results, gait analysis study (where required), and a written report to the referring physician and WorkSafeBC. Could be in place of fee code above, but not in addition to. includes report. If surgery is the recommended treatment and is being performed in hospital, bill under In-hospital surgical consultation - fee code If surgery is the recommended treatment and is being performed outside of hospital, bill under Surgical consultation - fee code Surgical consultation to include review of x-rays, blood work, etc., consultation with injured worker, and written report to injured worker s referring physician and WorkSafeBC. No additional report fee is billable. Billable only when non-referred case proceeds to podiatric surgery. Referred cases bill under Surgical consultation - fee code Cases not proceeding to surgery, bill under Podiatry visit - fee code $ $ $74.56 $76.80 $42.26 $ WorkSafeBC Payment Schedule for Podiatry Services March 1, 2019

4 Billable only under the following circumstances: (a) When unexpected complications arise following the 42-day post-operative period; or $30.66 $ Post-podiatric surgery visit (b) When post-operative care is provided by a different podiatrist within 42-day post-operative period in a different community (more than 50km from where the surgical procedure was performed); and (c) Only when the surgical procedure is authorized by WorkSafeBC (d) Invoice must be substantiated by a note record indicating how the criteria in notes a) and b) were met. Surgical and Other Procedures When two similar procedures are done at the same time, the charge for the second procedure is paid at 50 percent of the lesser scheduled fee; when done separately at staged intervals, the full fee should be charged for each procedure. In-hospital Special Surgical and Other Procedures In-hospital surgical consultation In-hospital surgical consultation to include review of x-rays, blood work, etc., consultation with injured worker, and written report to injured worker s referring physician and WorkSafeBC. No additional report fee is billable. (as of March 1, (as of January 1, $ $ WorkSafeBC Payment Schedule for Podiatry Services March 1, 2019

5 In-hospital incision and drainage In-hospital non-referred pre-operative assessment In-hospital incision and drainage superficial abscess (operation only). In-hospital non-referred pre-operative assessment. Billable only when non-referred case proceeds to podiatric surgery. Referred cases bill under In-hospital surgical consultation - fee code Cases not proceeding to surgery, bill under Podiatry visit - fee code $43.05 $44.34 $ $ Repair of Deformities of Joints of Lesser Toes (as of March 1, (as of January 1, Soft tissue repair only Soft tissue repair only $94.56 $ Arthroplasty (metatarso-phalangeal) Arthrodesis - interphalangeal with fixation Arthroplasty (metatarso-phalangeal) $ $ Arthrodesis - interphalangeal with fixation $ $ WorkSafeBC Payment Schedule for Podiatry Services March 1, 2019

6 Hallux Valgus (as of March 1, (as of January 1, Simple repair Simple repair $ $ Osteotomy and fixation Osteotomy and fixation $ $ Excision of neuroma Excision of neuroma $ $ Excision surgical or plantar keratosis Sesmoidectomy and accessory bones Exostosis of tarsal bones Excision surgical or plantar keratosis $94.56 $97.40 Sesmoidectomy and accessory bones $ $ Exostosis of tarsal bones $67.30 $69.32 Other Procedures (as of March 1, (as of January 1, Dislocations toes Dislocations toes $40.56 $ Dislocations M.P. Dislocations M.P. joints $40.56 $41.78 joints Fractures toes Fractures toes $53.92 $ Fractures metatarsal Fractures metatarsal $80.75 $ Excision granuloma Excision granuloma $67.30 $ Clavus (helomata) surgical, includes redressing Clavus (helomata) surgical, includes redressing $ $ WorkSafeBC Payment Schedule for Podiatry Services March 1, 2019

7 Nails - permanent Nails - permanent partial plate and matrix (includes $ $ partial plate and matrix redressing) Nails - complete nail Nails - complete nail and matrix removal (includes $ $ and matrix removal redressing) Nails - permanent Nails - permanent partial matrixectomy of both $ $ partial matrixectomy borders of the same digit (includes redressing) Ulcer debridement Ulcer debridement $58 $ Verruca - Surgical Verruca - Surgical excision $ $ excision Removal of foreign Removal of foreign body under local anaesthesia $32.51 $33.49 body Biopsy, skin Biopsy, skin (appropriate office visit additional) $13.13 $ Primary repair of softtissue Primary repair of soft-tissue wound $40.56 $41.78 wound Incision and drainage Incision and drainage superficial abscess (operation $43.93 $45.25 superficial abscess only) Removal of foreign Removal of foreign body requiring open exploration $94.56 $97.40 body Osteotomy Cutting a transection of bone with realignment $ $ Remodeling - metatarsal head Remodeling - phalangeal head Primary fixation (internal) Excision, removal of soft-tissue tumor Remodeling - metatarsal head $ $ Remodeling - phalangeal head $ $ Billable in addition to Remodeling - metatarsal head - fee code and Remodeling - phalangeal head fee code Excision, removal of medium-sized benign soft-tissue tumor where general anaesthetic or regional block is necessary $53.92 $55.54 $ $ Tenodesis Tenodesis $94.56 $ Tendon lengthening Tendon lengthening $94.56 $ WorkSafeBC Payment Schedule for Podiatry Services March 1, 2019

8 Miscellaneous procedure fee item Surgical procedures not listed elsewhere in this fee schedule. Provide detail of the procedure with a suggested fee when submitting the podiatrist invoice to WorkSafeBC. Such claims will be subject to individual adjudication by the WorkSafeBC Health Care Services Department. Fax to It can be billed up to a maximum of the amount indicated Surgical assistant fee Applicable to the total fee payable under the multiple surgery rule for the following procedures: Osteotomy Remodeling - metatarsal head Remodeling - phalangeal head Excision, removal of soft-tissue tumor Hallux Valgus o Simple repair o Osteotomy and fixation o Excision of neuroma o Exostosis of tarsal bones Up to $ Up to $ Payable at 30 percent of surgical fee. Payable at 30 percent of surgical fee Surgical Tray fee Actual cost of supplies. No mark-up is permitted. Retain receipts for audit purposes. Actual cost of supplies. Actual cost of supplies. Other Services Telephone consultation Consultation with a WorkSafeBC officer, or community health professional; e.g. GP physician, surgeon, physiotherapist WorkSafeBC Request for a copy of an Existing Report WorkSafeBC Request for a copy of an Existing Report- Up To 20 Pages, Received Within 3 Days (as of March 1, $53.67 per 15 mins; up to 45 mins (as of January 1, $55.28 per 15 mins; up to 45 mins $44.23 $ WorkSafeBC Payment Schedule for Podiatry Services March 1, 2019

9 WorkSafeBC Additional Charge Per Page Additional Charge Per Page For Over 20 Pages (continuation of or 19905) $1.33 $ WorkSafeBC Request for a copy of consultation, operative, or other existing report, first 5 pages or less WorkSafeBC Requested Copy of an Existing Chart Note (requires isolating information) WorkSafeBC Request for a copy of consultation, operative, or other existing report, first 5 pages or less WorkSafeBC Requested Copy of an Existing Report or Chart Note (Isolating Information) $27.64 $28.47 $ $ X-ray general lower extremity X-ray special requested additional views X-ray general lower extremity $40.12 $41.32 X-ray special requested additional views $17.17 $ Adequate clinical record means a record of a podiatrist, prepared in accordance with this payment schedule, that contains sufficient information to allow another health care practitioner, who is unfamiliar with both the injured worker and the attending podiatrist, to determine from that record, together with the injured worker s clinical records from previous encounters, information about the service provided to the injured worker including: (a) The date, time and location of the service; (b) The identity of the injured worker, including valid WorkSafeBC claim number, and the attending podiatrist; (c) If the service resulted from a referral, the identity of the referring practitioner and the instructions and requests of the referring practitioner; (d) The presenting complaints, symptoms and signs, including their history; (e) The pertinent previous history including family history; (f) The positive and negative results of a systematic inquiry relevant to the injured worker s problems; (g) The identification of the extent of the physical examination and all relevant findings from that examination; 9 WorkSafeBC Payment Schedule for Podiatry Services March 1, 2019

10 (h) The results of any investigations carried out during the encounter; (i) The differential diagnosis, if appropriate; (j) The provisional diagnosis; (k) The summation of the injured worker s problems and the plan for their management 10 WorkSafeBC Payment Schedule for Podiatry Services March 1, 2019