Healthcare providers play a pivotal role in managing diabetes and ensuring patients receive the necessary care while navigating billing complexities effectively. This includes scheduling follow-up appointments for ongoing support and monitoring.
We’ve teamed up with our partners at DoctorCare to create a comprehensive guide on diabetes management billing best practices, specifically tailored for your convenience in OSCAR Pro.
Key Fee Codes for Diabetes Management
K030 – Diabetes Management Assessment
The K030 code is central to diabetes management, covering the all-inclusive service for the continuing management and support of diabetic patients. This code is payable to the most responsible physicians for ongoing care. The fee value is $40.55 and can be billed four times every 12 months.
To bill the K030 code:
- Diagnostic Code: Use the diagnostic code 250.
- Service Day Restrictions: The K030 cannot be billed on the same day as any other consultation; if it is, it will be paid at $0.
- Patient Recall: Add a notification reminder in the EMR to recall patients.
Q040 – Diabetes Management Incentive
The Q040 code provides an incentive for physicians managing diabetic patients using a planned care approach in line with Diabetes Canada’s guidelines. The fee value is $60 and can be billed once every 12 months.
K029 – Insulin Therapy Support
The K029 code supports physicians providing intensive insulin therapy or training for patients using glucose meters, insulin pumps, or insulin pens. The fee value is at $70.10 and can be billed six times per calendar year.
To bill the K029 code:
- Combination Billing: It is recommended to bill K029 alongside the third K030 for the same patient within 365 days. It can be submitted separately or with other codes.
- Eligibility: Ensure the patient is receiving at least three insulin injections per day or using an insulin pump.
Virtual Billing Requirements
K030, K029 and Q040 can be billed for virtual visits under specific conditions:
- Initial Physical Encounter: A virtual K030 is eligible for payment only after a K030 involving a direct physical encounter has been billed.
- Separate Claim: Q040 must be billed on a separate claim for a virtual diabetic visit.
Practical Tips for Efficient Diabetes Management in OSCAR Pro
Create a Flow Sheet
Creating a flow sheet in the EMR helps track the progress of diabetic patients. Download our quick reference guide to learn how.
Create a Measurement Group
A measurement group can be used to track specific metrics for diabetic patients. This group can be assigned to a flow sheet or used independently. Download our quick reference guide to learn how.
Generate Reports for Diabetes Recall Patients
Generate reports by registering patients with the ICD-9 code in the Disease Registry of the eChart. Create a custom report template to pull up a list of these patients at any time, facilitating timely follow-ups. Download our quick reference guide to learn how.
Tickler Tool for Patient Recalls
Manage patient recalls efficiently by creating a tickler in the EMR. Set it to a future date for your staff to book follow-up appointments. Watch the OSCAR Pro Tickler Tool video for detailed instructions.
Create a Super Code
To simplify billing, you can create a Super Code combining K030 and Q040. Download our quick reference guide to learn how.
Common Billing Errors and Solutions
| Error Codes | How to Resolve |
| M1 – Max Fee Allowed for These Services Has Been Reached | This error indicates that the maximum number of billable services for a code has been exceeded. Track your billing to avoid surpassing the limits. |
| MR – Minimum Service Requirements Not Met | This error occurs when prerequisite services have not been met. For instance, you must bill three K030’s for the same patient within 365 days before billing a Q040. |
Effective diabetes management is crucial for maintaining the health and well-being of diabetic patients. This proactive approach not only improves patient outcomes but also ensures that healthcare providers can efficiently manage their practice.
By integrating these practices into your routine, you can enhance the quality of care for your diabetic patients, ensuring they receive the support and management they need to thrive.