Fee items for telephone advice include 13000 and 13005.
Fee Item 13000 - Telephone Advice to a Community Health Representative in a First Nation's Community
Fee item 13000 can be used only when:
- Medical advice is provided by the physician by telephone to a Community Health Representative who initiated the medically required call; and
- A Community Health Nurse is not available in that community.
When submitting a claim for fee item 13000, bill under the personal health number (PHN) of the patient on the date that the service was rendered.
Fee Item 13005 - Advice about a Patient in Community Care
Fee item 13005 can be used only when medical advice is provided by the physician by telephone, fax or in written form about a patient in community care to an allied health care worker who initiated the call and is specifically assigned to that patient. Note that:
- Community care comprises Residential, Intermediate and Extended care, and includes patients receiving Home Nursing care, Home support, or Palliative care at home.
- Allied health care workers include:
- home care coordinators
- nurses (registered, licensed practical, public health and psychiatric)
- mental health workers
- occupational therapists
- respiratory therapists
- social workers
- ambulance paramedics, and
- pharmacists (other than for prescription renewal)
- When billing a claim under fee item 13005:
- bill the claim under the personal health number (PHN) of the patient
- include the time of day that the request for advice was received
- This fee may be billed only once per patient per physician per day.
- This fee cannot be used for advice in response to an enquiry by the patient or his/her family.
- This fee cannot be claimed in addition to a visit or other service provided on the same day to the same patient by the same physician.
- This fee may not be claimed by a physician who is:
- on third party call to a facility
- on-site, on-duty in an emergency department
- being paid on a sessional basis at that time
- working as a hospitalist at that time
- receiving non-fee-for-service compensation for providing coverage at a continuing care facility during normal business hours
- This fee item cannot be billed for calls about doctor of the day patients to a physician who is on call for doctor of the day at the time the request for advice is made.
- This fee item requires that the following documentation be maintained in the physician's office and recorded in the patient's file:
- date of service
- name of the allied health care worker who initiated the request
- a brief notation of the advice given or original fax or copy of written advice