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Activity 3-2 - Assessment + Diagnostic-Therapeutic Claims - Fillable - Correct - Final

This document provides information on claiming diagnostic and therapeutic procedures under the Schedule of Benefits. It explains that these procedures have their own section in the Schedule and can be performed by a physician or their staff. When a diagnostic or therapeutic procedure is performed along with a physician assessment, the assessment is claimed first, followed by the procedure codes. For some procedures marked with a plus sign, the G700 code can also be added to indicate it was the sole reason for the visit. However, G700 cannot be claimed if the physician has a financial interest in the facility where the service was provided. The document provides examples of claims for common procedures and assessments.

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jerrymorgan291
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38 views2 pages

Activity 3-2 - Assessment + Diagnostic-Therapeutic Claims - Fillable - Correct - Final

This document provides information on claiming diagnostic and therapeutic procedures under the Schedule of Benefits. It explains that these procedures have their own section in the Schedule and can be performed by a physician or their staff. When a diagnostic or therapeutic procedure is performed along with a physician assessment, the assessment is claimed first, followed by the procedure codes. For some procedures marked with a plus sign, the G700 code can also be added to indicate it was the sole reason for the visit. However, G700 cannot be claimed if the physician has a financial interest in the facility where the service was provided. The document provides examples of claims for common procedures and assessments.

Uploaded by

jerrymorgan291
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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HEALTH CLAIM ACTIVITY 3-2

Assessments Plus Diagnostic and Therapeutic Procedure Health Claims

Diagnostic and therapeutic procedures have their own section in the Schedule of
Benefits. This section of the Schedule of Benefits identifies diagnostic and therapeutic
procedures (not major surgical procedures) and can be found in the Schedule of Benefits from the main menu as
DIAGNOSTIC AND THERAPEUTIC PROCEDURES. Diagnostic and therapeutic procedures can be
performed by a physician or a member of physician’s staff in his/her office or in an institutional/hospital setting in
order to diagnose or treat a patient’s medical condition.

Diagnostic and therapeutic procedures can be added to a visit code or billed separately.

If the diagnostic and therapeutic procedure is performed by a physician the assessment claim is completed first,
followed by the diagnostic and therapeutic procedure code(s).

Some procedures in the SOB have a plus sign (+) sign in front of the code. If the procedure has a plus sign
(+) in front of the procedure code you can add G700 to the claim—but only if the procedure is the sole
reason for the visit. It is called a basic fee-per-visit premium. For example, if the Doctor performed a bilateral
ear syringe (only), then you would claim for the diagnostic and therapeutic procedures first (G420) PLUS the
G700. If the physician is claiming for an assessment or consultation code you CANNOT claim for the G700,
as the procedure must be the sole reason for the visit. Note: this is not applicable for services provided in a
hospital.

April 1, 2012

PAMBLE
OTHER TERMS AND DEFINITIONS (from the SOB)

Services listed in the Diagnostic and Therapeutic Procedures Section are eligible for payment in addition to a
consultation or assessment except where they are specifically listed as included in consultation or assessment
services. When a procedure(s) is the sole reason for a visit, add G700, the basic fee-per-visit premium for those
procedures marked (+) regardless of the number of procedures carried out during that visit. However, G700 is
not eligible for payment to a physician in situations where:

1. a consultation or assessment is payable to the same physician for the same patient on the
same day; and

2. that physician has a financial interest in the facility where the service is rendered.

Note:
1. G700 is not eligible for payment for a service provided in a hospital.
2. G700 is not eligible for payment when the service marked with (+) is not eligible for
payment.

3. G700 is payable at 15% of the listed fee when the service is rendered to a patient who has signed the
Ministry's Patient Enrolment and Consent to Release Personal Health Information form and who is enrolled to
a physician or group of physicians who are signatories to a Ministry alternate funding plan agreement paying
physicians primarily by capitation rather than fee for service, applicable regardless of which physician of the
group renders the service to the enrolled patient.
Fee
G700 Basic fee-per-visit premium for procedures marked (+)............. 5.10

Page 1
DIAGNOSTIC AND THERAPEUTIC PROCEDURES

Instructions:
1. Look-up the following assessment codes and diagnostic and therapeutic procedure codes using
the Schedule of Benefits
2. Record the codes on the lines provided
3. Identify if the code(s) require the use of the extra code G700

Note: All services were performed in the physician’s office.

1. Patient was seen by the doctor for a Minor Assessment (_________)


A001A plus bilateral Ear Syringing (_________).
G420A

Are you claiming more than one item? Y N Y

Can you add a G700 code to this claim? Y N N

Can you claim for both sides (Bilateral) for syringing? Y N N

2. Patient was seen by the doctor for an Intermediate Assessment for Well Baby (___________)
A007A plus Diphtheria,
Tetanus, and Acellular Pertussis vaccine/Inactivated Poliovirus vaccine (____________).
G840A

Are you claiming more than one item? Y N Y

Can you add a G700 code to this claim? Y N N

3. Patient was seen by the nurse for Hyposensitisation (sole reason for visit- including first injection) (___________).
G212A
Patient was not seen by the doctor.

Are you claiming more than one item? Y N N

Can you add a G700 code to this claim? Y N N

4. Patient received Influenza agent by the nurse (___________).


G590A Patient was not seen by the doctor.

Are you claiming more than one item? Y N Y


Can you add a G700 to this claim? Y N
Y
5. Adult female patient (aged 30) was seen by the doctor for a Periodic Health Visit (__________)
K131A plus Papanicolaou
Smear (Pap Smear) (___________
G365A & _____________).
E430A

Are you claiming more than one item? Y N Y


Can you add a G700 code to this claim? Y N
N
6. Patient was seen by the nurse for a bilateral ear syringing by nurse (_____________).
G420A Patient was not seen by the
doctor.

Are you claiming more than one item? Y N Y


Can you add a G700 to this claim? Y N Y

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