Concept: Virtual or Telephone Physician Visits

Introduction

The following concept describes the methods used to identify virtual or telephone physician/nurse practitioner visits, and other types of physician services provided that do not involve in-person physician / patient contact. These types of services are recorded in the Medical Services / Physician Claims data.

Due to the Coronavirus (COVID-19) pandemic that began in Manitoba in March, 2020, these types of services are becoming more prevalent.

Virtual or Telephone Physician Visits

A virtual or telephone physician visit is a physician/nurse practitioner service provided to a patient without any direct or face-to-face contact. These services may include an internet video or telephone call between a physician/nurse practitioner and a patient. Physicians/nurse practitioners will invoice for these services as regular patient visits, and these visits would typically be included as an ambulatory visit, unless explicitly excluded.

The list of virtual and telphone physician/nurse practitioner tariff codes includes:



PREFIX	TARIFF CODE	TARIFF DESCRIPTION
7	8000	TELEPHONE/FACSIMILE/E-MAIL COMMUNICATIONS INITIATED BY ALLIED HEALTH CARE PERSONNEL
7	8001	TELEPHONE/FACSIMILE/E-MAIL COMMUNICATION TO A SPECIALIST OR GENERAL PRACTITIONER
7	8002	MONITORING ANTICOAGULANT THERAPY - BY TELEPHONE, FASCIMILE, OR EMAIL PER CALENDAR MONTH
7	8003	TELEPHONE/FACSIMILE/EMAIL COMMUNICATIONS - EDS APPROVAL
7	8005	TELEPHONE/FACSIMILE/EMAIL COMMUNICATIONS INITIATED BY PHARMACISTS
7	8100	CASE MANAGEMENT COMMUNICATION BY FAX/EMAIL/TELEPHONE INITIATED BY PATIENT/FAMILY/FRIEND
7	8101	CASE MANAGEMENT COMMUNICATION BY FAX/EMAIL/TELEPHONE INITIATED BY RN(EP)
7	8284	VIRTUAL VISIT BY TELEPHONE OR VIDEO-PATIENT AGED 65 - 69 YEARS
7	8285	VIRTUAL VISIT BY TELEPHONE OR VIDEO-PATIENT AGED 70 YEARS OR OVER
7	8321	VIRTUAL VISIT BY TELEPHONE OR VIDEO
7	8411	SUBSEQUENT VOICE CONSULTATION
7	8442	COMPREHENSIVE VIRTUAL ASSESSMENT BY GENERAL PRACTITIONER
7	8447	COMPREHENSIVE VIRTUAL ASSESSMENT BY SPECIALIST
7	8478	TELEMEDICINE SERVICE - PSYCHIATRIC CARE
7	8479	TELEMEDICINE SERVICE - INDIVIDUAL PSYCHOTHERAPY
7	8480	LIVE TELEMEDICINE SERVICE
7	8481	STORE AND FORWARD TELEMEDICINE SERVICE
7	8482	TELEMEDICINE SERVICE - ASSISTING PHYSICIAN
7	8486	FOLLOW-UP TELEPHONE/FAX/E-MAIL COMMUNICATIONS BY NEUROLOGIST PROVIDING TELESTROKE SERVICES
7	8521	VIRTUAL CONSULTATION BY TELEPHONE OR VIDEO, INVOLVING CHILD OR GERIATRIC PATIENT BY PSYCHI
7	8527	CHRONIC CARE VIRTUAL VISIT BY TELEPHONE OR VIDEO
7	8533	VIRTUAL PSYCHOTHERAPY BY TELEPHONE OR VIDEO
7	8535	VIRTUAL CONSULTATION BY TELEPHONE OR VIDEO
7	8655	VIRTUAL PSYCHOTHERAPY BY TELEPHONE OR VIDEO BY NON-PSYCHIATRIST
7	8786	VIRTUAL PSYCHIATRIC CARE BY TELEPHONE OF VIDEO

Other Types of Visits without Patient Contact:

There are also other types of visits that occur without patient contact, including:

1. Direct Physician/Nurse Practitioner to Physician Consult

Physicians/nurse practitioners may consult other physicians regarding a concern for their patient, and these consults are invoiced as a service but again the patient has no direct physician contact for that service.

The list of direct physician/nurse practitioner to physician consult tariff codes includes:



PREFIX	TARIFF CODE	TARIFF DESCRIPTION
7	8006	GENERAL PRACTITIONER TO PSYCHIATRIST TELEPHONE CONSULTATION:REFERRING GENERAL PRACTITIONER
7	8007	CONSULTING PSYCHIATRIST,DIRECT PHYSICIAN TO PHYSICIAN TELEPHONE RESPONSE WITHIN 2 HOURS
7	8008	CONSULTING PSYCHIATRIST,DIRECT PHYSICIAN TO PHYSICIAN TELEPHONE RESPONSE WITHIN 48 HOURS
7	8009	PAEDIATRICIAN TO PSYCHIATRIST TELEPHONE CONSULTATION-REFERRING PAEDIATRICIAN

2. Annual Management of Complex Patient

Beginning in 2012/13, Manitoba Health introduced annual management tariffs for complex patients, such as patients with certain chronic diseases or requiring other complex care. A physician/nurse practitioner can invoice for this type of service once per year per patient if they can prove that they have met certain benchmarks in managing their patient’s care. These tariff codes do not reflect an actual visit of a patient to doctor, rather they are an incentive for physicians to ensure they are doing proper management of complex patients.

For example, in order for a physician to invoice for tariff code 8431 “Annual management of Diabetes, including development of patient care plan” requires the following conditions be met:


1. Applicable only for patients with confirmed diagnosis of Diabetes.
   
2. Tariff 8431 is payable only to the general practice physician who has provided the majority of the patient’s ongoing comprehensive care in relation to the active management of Diabetes during the preceding twelve (12) months.
   
3. Tariff 8431 may only be billed upon provision of the following services:
   
   1. Blood pressure measurement;
      
   2. Foot examination or management of documented peripheral neuropathy;
      
   3. Fundoscopic examination or referral for a fundoscopic examination;
      
   4. Full fasting lipid profile screening (for patients from 18 years of age to 74 years of age);
      
   5. HGB A1C test;
      
   6. Nephropathy screening;
      
   7. Obesity/overweight screening;
      
   8. Ongoing coordination with other allied health care providers respecting management of patient condition and patient care plan as appropriate;
      
   9. Ongoing communication with patient, monitoring of patient condition and patient care plan as appropriate.
4. Tariff 8431 may only be billed once per patient during any twelve (12) month period.
   
5. The services in #3 above must be documented and provided to Manitoba Health either a) by an electronic medical record compatible with Manitoba Health’s information system or b) by completing Manitoba Health’s patient care treatment form which shall be forwarded to Manitoba Health either electronically or by fax.
   
6. Claims for additional services rendered to a patient (e.g., visits) may be made in addition to this tariff.

Source: Manitoba Health, Seniors and Active Living; Manitoba Physician's Manual, April 1, 2020. - accessed April 12, 2021.

The list of specific tariff codes for the annual management of complex patients includes:

Introduced in 2012/13:



PREFIX	TARIFF CODE	TARIFF DESCRIPTION
7	8431	ANNUAL MANAGEMENT OF DIABETES INCLUDING DEVELOPMENT OF PATIENT CARE PLAN
7	8432	ANNUAL MANAGEMENT OF ASTHMA INCLUDING DEVELOPMENT OF PATIENT CARE PLAN
7	8433	ANNUAL MANAGEMENT OF CONGESTIVE HEART FAILURE INCLUDING DEVELOPMENT OF PATIENT CARE PLAN
7	8434	ANNUAL MANAGEMENT OF CORONARY ARTERY DISEASE INCLUDING DEVELOPMENT OF PATIENT CARE PLAN
7	8435	ANNUAL MANAGEMENT OF HYPERTENSION

Introduced in 2017/18:



PREFIX	TARIFF CODE	TARIFF DESCRIPTION
7	8454	ANNUAL MGMT PRIMARY CARE PATIENT BETWEEN 50-74 YEARS WITHOUT A CHRONIC DISEASE
7	8455	ANNUAL MGMT PRIMARY CARE PATIENT 75 YEARS AND OVER WITHOUT A CHRONIC DISEASE
7	8456	ANNUAL MGMT PRIMARY CARE PATIENT DIAGNOSED WITH ONE CHRONIC DISEASE
7	8457	ANNUAL MGMT PRIMARY CARE PATIENT DIAGNOSED WITH TWO CHRONIC DISEASES
7	8458	ANNUAL MGMT PRIMARY CARE PATIENT DIAGNOSED WITH THREE OR MORE CHRONIC DISEASES


For more information, please see pages 161-166 in the Manitoba Physician's Manual.