Can I bill a call to a specialist for advice (8356) in Manitoba?

The fees

When it applies

The manual's term for 8356 is "Telephone/Videoconference communications to a Consultant Physician – Referring Physician" (B-12). The consultant's side of the same call is 8355 (B-12). The manual gives 13 notes for the two tariffs (B-12 to B-13). This page lists the ones about the side of the physician who makes the call. So the list is partial.

• Phone or video. The tariff's wording is "Telephone/Videoconference" (B-12). Fax and email are not named in it.
• Who may claim. The manual gives one list for both tariffs: "Tariff 8355 and 8356 may be claimed by:" (B-12). Each note first names the physician who takes the call. Then it names who the call comes from. Three notes can apply when a family physician makes the call:
  • "A Specialist for communications from a Specialist, General Practitioner, RN (EP), Physician Assistant (PA), Clinical Assistant (CA), or midwife regarding a patient who is receiving medical care from the Physician or RN (EP) who initiated the communication" (B-12, note i). RN (EP) means a registered nurse (extended practice).
  • "A General Practitioner for communications from a General Practitioner, RN (EP) Physician Assistant (PA), Clinical Assistant (CA), or midwife regarding a patient who is receiving medical care from the Physician or RN (EP) who initiated the communication." (B-12, note ii)
  • "A General Practitioner with expertise in Addictions Medicine, Palliative Care, Care of the Elderly, Anesthesia or Obstetrics, from a Specialist, General Practitioner or RN (EP) regarding a patient who is receiving medical care from the practitioner who initiated the communication." (B-12, note iii)
  • This page reads 8356 as the claim of the physician who makes the call. That reading comes from the tariff's name: "Referring Physician" (B-12).
• The consultant's advice: "May only be claimed when the consultant has provided an opinion and recommendation for patient treatment, and management after reviewing pertinent family/patient history of the presenting complaint, and discussion of the patients condition and management after reviewing laboratory and other data where indicated." (B-13, note viii)
• The purpose of the call: "The purpose of the call is to seek the advice of a physician more experienced in treating a presenting problem. It is the expectation that the referring physician, nurse practitioner, midwife or podiatric surgeon will continue to care for the patient." (B-13, note ix)

When it does not apply

• "May not be claimed for situations where the purpose of the call is to:" (B-13, note x)
  • "Arrange for an expedited consultation or procedure within 24 hours except when the conditions are met."
  • "Arrange for laboratory or diagnostic investigations."
  • "Discuss or inform the referring physician or podiatric surgeon of results of diagnostic investigations."
• Same day as 8001: "Tariff 8001 may not be claimed on the same day as 8355 Telephone/Video Conference Consultant Physician or 8356 Telephone/Video Conference Referring Physician." (B-10, 8001 note 2) Tariff 8001 is the fee for a phone call, fax or email another physician starts with you (B-9).

Limits

• "A maximum of any two 8355, 8356 claims may be claimed per patient, per physician per day." (B-13, note xi)

Records

• "Documentation must be recorded by both the referring physician, RN (EP) or designated allied health provider and the consultant in their respective records." (B-13, note xii)
• The 8355 and 8356 notes (B-12 to B-13) do not list what the claim itself must include.

Not settled by the pages we checked

• Whether 8356 depends on the consultant claiming 8355. The 8355 and 8356 notes (B-12 to B-13) do not say.
• Which conditions note x means. Its words are "except when the conditions are met" (B-13, note x). Note x does not say which conditions.
• A call to a psychiatrist. Tariff 8006 is the "Referring General Practitioner" fee for a "General Practitioner to psychiatrist telephone consultation" (A-126). "8006 is payable only when a corresponding 8007 or 8008 is completed by the psychiatrist." (A-126) The pages we checked do not say when to bill 8006 rather than 8356.
• This page is about calls you make. For a call or message another physician starts with you, see the 8001 page under Related questions.

Worked example

What is often not billed

• Your own claim for a call you made. When you phone or video-call a consultant for advice about your patient, 8356 pays $26.53 for that call (B-12). It is payment for the call you made for your patient's care. It may only be claimed when the consultant has provided an opinion and recommendation for the patient's treatment and management (B-13, note viii). Documentation must be recorded by both of you in your own records (B-13, note xii). Our suggestion, not a Manitoba Health rule: write down who you called and the time of the call. Also write the consultant's opinion and recommendation and the plan you will carry out. Before you claim, check that no 8001 is claimed on the same day (B-10).