Longitudinal Family Physician Payment Model

ICD-9 coding best practices for LFP clinic-based care and facility-based care

Physicians enrolled in the LFP Payment Model receive a Panel Payment for the size and complexity of their empanelled patients. ICD-9 codes are used in part to determine patient complexity. Below are ICD-9 coding best practices to accurately capture patient complexity in your practice.

1. Submit the most specific ICD-9 codes for the patient interaction
   • Submit billing claims with ICD-9 codes that most appropriately represent the nature of the service provided at the interaction– i.e. the patient’s presenting symptoms and/or confirmed diagnosis.
   • Don’t use 780 (general symptoms) for every interaction.
   • Remember, ICD-9 codes are not only used for calculating your patient’s complexity. There are other implications if records are requested for insurance or medicolegal reasons.
   • Example: Use 02A (gastrointestinal symptoms) instead of 780 (general symptoms).
2. Use symptom-based ICD-9 codes during diagnostic workup/testing
   • Use ICD-9 codes that describe symptoms when you see a patient for a diagnostic workup or diagnostic testing.
   • ICD-9 codes for diagnosis should only be used when the condition is confirmed.
   • Example: Use the ICD-9 code for chest pain (7865) instead of angina (413) until such time that it is confirmed to be angina.
3. Use ICD-9 codes to the furthest digit to accurately capture complexity
   • 4- or 5-digit ICD-9 codes are more specific than 3-digit codes.
   • When applicable, use 4- or 5-digit codes.
   • Example: Instead of using 427 (cardiac dysrhythmia), use 42731 (atrial fibrillation) as this is more specific.
4. Submit up to three ICD-9 codes per interaction
   • If you manage more than one condition at a visit, use more than one ICD-9 code for the claim submission.
   • If applicable, you can submit up to three ICD-9 codes per billing claim.
   • Example: If you see a patient for hypertension (401), hypothyroidism (244), and knee osteoarthritis (71517), submit all three ICD-9 codes on the billing claim.

Additional resources:

• MSP: Index and Guide to 3-digit and 4-digit ICD-9 code descriptions
• BC Family Doctors: Two-page summary of common family medicine 3-digit ICD-9 codes to assist physicians with more accurate use of ICD-9 Codes
• Canadian Institute for Health Information: Population Grouping Methodology (POP Grouper)
• For questions about the Panel Payment, please email fp.billing@doctorsofbc.ca

LFP facility-based care billing tip videos

These short 3-minute videos provide information and guidance for specific LFP codes and billing questions. Check out the full playlist on the Doctors of BC YouTube LFP channel.

Facility-based conferencing and communication codes:

• Interdisciplinary Care Conference
• Family Conference
• Team Communication

Long-term care and palliative care:

• Admission
• Discharge
• End of Life

Inpatient care:

• Admission
• Discharge
• Transfer of Care from another Physician/Service
• End of Life

Facility-based pregnancy and newborn care:

• Birth
• Pregnancy-related Surgical Assist
• Billing Across Calendar Days

LFP Facility-based webinar recordings

• LFP Billing for Long-Term and Palliative Care
• LFP Billing for Inpatient Care
• LFP Billing for Pregnancy and Newborn Care

The webinars review:

• Eligibility and registration
• Time codes
• Interaction codes

As there is a lot of LFP Payment Model content to cover, the webinars will not provide additional information about FPSC supports for these areas of care.

Additional supports

• If you have any questions or need further assistance, please contact the FPSC billing support team at FP.Billing@doctorsofbc.ca.
• Visit the BC Family Doctors website (login required) to access a Simplified LFP Guide, Billing Question Library, and other useful tools.
• For more information on clinical supports, visit the FPSC clinical supports page.
• Visit the Ministry of Health LFP page for further information and historical LFP Payment Schedules.