Monitoring Anticoagulant Therapy — Tariff 8002
Tariff 8002 is claimable for monitoring the condition of a patient receiving anticoagulant drug therapy.
The guidelines/requirements of this tariff are as follows:
- The tariff is a monthly fee (not a visit fee) and should be billed once per calendar month for each patient receiving anticoagulant therapy.
- The tariff is intended to compensate physicians for the ongoing responsibility of monitoring the condition of the patient and includes the provision of teh following services:
- ordering blood tests;
- interpreting results
- inquiry into possible complications
- adjusting the dosage of anticoagulant (if indicated).
These services may be provided via telephone, facsimile or email communications. However, a claim under Tariff 8002 does not have to correspond to a particular “communication”. For example, in a given month, the monitoring of a particular patient might consist of only a review of lab results, with no “communications” respecting the patient taking place. In another month, the monitoring of that patient might entail several “communications” (either by telephone, facsimile or email) between the physician and/or their office staff and the patient, a pharmacist, family members etc. Tariff 8002 is payable in each of those months.
- Claims for additional services rendered to the patient (e.g., visits) may be claimed in addition to the tariff.
Claim Tariff 8002 regardless of the location of the patient, and applies to hospital in-patients, personal care home residents and at-home patients.
For ease of billing, some physicians choose a day of the month (e.g., 1stday of month, last day of month etc.) and bill Tariff 8002 with respect to all patients receiving anticoagulant therapy on this same day each month. Physicians may also choose to bill Tariff 8002 on a quarterly basis for patients receiving anticoagulant therapy, indicating the service date for each month for which they are billing. Either method of billing is acceptable to Manitoba Health.
Although there is no prohibition against claiming Tariff 8002 on the same service date as a patient visit, doing so will result in one of the claims “failing” in Manitoba Health’s claims processing system for “manual intervention”. Although this “failed” claim will ultimately be paid, it is important to monitor your remittance statements to ensure that the claim is, in fact, paid. To avoid the delays associated with such a failure, some physicians elect to claim the tariff with a service date on the 1st (or last) Saturday or Sunday (non-office day) of each month, so as to avoid the possibility of the selected service date coinciding with the date of a patient visit.
Tariff should be claimed by the physician most responsible for monitoring the patient’s condition respecting the anticoagulant therapy.
- A hospital in-patient is placed on anticoagulant therapy by a specialist, and is thereafter discharged to the community under the care of a family physician. The physician who should claim under the tariff is the physician who was responsible for monitoring the condition of the patient with respect to the anticoagulant therapy for the majority of the particular month.
- Where the hospital in-patient has undergone major surgery, and where it is the surgeon who is responsible for monitoring the condition of the patient with respect to the anticoagulant therapy for the majority of that particular month, the surgeon may claim this tariff, despite the fact that the service date may fall within the three-week post operative period.