I hope this newsletter finds our members doing well and healthy despite the miserable “spring” we have had in Ontario. We can only hope that the predictions for a “hotter than usual” June, July & August come true.

It would appear that the Arthroscopic “2 R codes” problem has mostly settled with the action of the OMA board after this became apparent. The OMA and the MOH have agreed to allow 2 R codes without the mandatory review for most routine procedures. However, I am still receiving the occasional report of denied and/or significant delays in payment. We are trying to work through these with our contacts at the OMA. Dana Fleming is doing the majority of work in this area with his experience as Tariff Chair. Be sure to review his “Billing Corner” for tips and tricks to try and stay ahead of the game.

The AGM is on track again for this year. It will be at the Westin Prince Hotel the weekend of November 4 & 5th. Plan to attend, as Co-Chairs David Bardana and Jeremy Hall have an excellent academic and practical program as usual. As those who have attended will know, it is extremely good education for its value! Further information will be available as the program is finalized.

I read with interest Dana Fleming’s article in our last newsletter about EMR’s. I have been currently investigating changing my practice over to EMR. The decisions are not easy and I suggest you consult as many experts as possible. Also, the Ontario government has already allocated all the funds they have set aside for specialists. However, you are encouraged to apply as they feel there is a “good business case” to provide more funding for our group. It is important to know that if you purchase an EMR without prior approval, you will not be eligible for funding.

I am looking forward to seeing many of you at the COA meeting, the 1st week of July on “The Rock”. As we all know, Newfoundlanders are great hosts and it should be a great event both academically and socially. Don’t miss “The Kitchen Party” on Saturday night.

I hope you enjoy our spring newsletter. I wish you a happy and restful summer. Please enjoy!

The last months have been very frustrating, as there appeared to be a reasonable discussion regarding the use of the BMI code. All of the surgical divisions were arguing that the obese patient was more difficult to care for and that the fees should apply to all procedures, or at least many more than what are
currently allowed. Many emails later, the whole surgical section was advised that the Ministry had brought this up to actually limit the current use ofthe BMI code (E676) more than it is now. Essentially they made it a general surgical code (abdominal code) only for surgeons. The Anaesthetists can still charge it. I had hopes that they would allow shoulder codes as well as hip codes to bill this extra, but this is not to be. BUT you can bill the extra code for Hip procedures R439, R440, R240 etc. So if the patient’s BMI is documented in the chart as greater than 40 (your anaesthetist will know), bill this code. I hope most of you have been able to bill the new arthroscopic code to some advantage. I realize there were problems to begin with but those have been fixed to a large degree with a list of open codes that can be associated with arthroscopic codes.

Yes, I know, all codes should be able to be billed with arthroscopic codes since we are trying to do everything through a pin hole but this is not the fact of life. Now you can bill an R687 with R542 and E496 (meniscal repair), E552, if you need to do an extensive debridement you can charge an E494 as well. Similarly if you bill a shoulder procedure you can bill an R684 with an E484 for a stabilization, you will make a little more than if you bill an R401 because of the 80% rule with two R codes (not much I must add).

If you are doing a rotator cuff repair you can bill an R684 with an R594 if you are attaching to bone but include that term in your dictation, as that is the definition of a complex rotator cuff tear.

For the foot and ankle surgeons: we have requested an increase in the base fee R688, as you have requested. If granted by the OMA/MOH that fee will be increased to be equal to $400 as with all of the other joint fees of a similar nature. The knee base fee remains at 97 dollars. For all of you that biopsied every joint and received the usual answer of non-specific inflammatory changes, that is still included in the base fee for all joints.

I recently attended the OMA Council Meeting in Toronto, April 29, 30, & May 1 as your President/Section Chair for Orthopaedics.

Friday was a new event for the OMA, where members of council were asked to comment and participate in policy decisions. The subject was eHealth. It was fairly interesting to discuss the ramifications of eHealth and the associated potential conflicts with patient confidentiality. Many problems with current systems and their ability to communicate and exchange information with other systems exist. My overall opinion is that eHealth/EMR is a good idea but the system needs significant tuning before the potential benefits are achieved.

OMA has negotiated a new Form Fee for Form 8. The form has been simplified and now pays $65. It pays $75 when completed online but apparently there are problems with the WSIB Telus website. The E676 Obesity Code was discussed. The reasons for including most procedures on obese patients were discussed. However, there is no interest at the OMA to extend this code to other procedures. In fact,since the OMA meeting this code has been further defined to include only procedures performed in the perineum, retro-perineum, and pelvis, which would eliminate hip procedures that I believe were included before.

CANDI was discussed, passionately as usual. Price-Waterhouse reported the results of their voluntary survey. They received a response rate of 8.7% from the OMA members. Many thought that this small number would not validate any findings they have. The company states that they need to do the site visits before they can comment on validations and degree of accuracy. Interesting, less than half the physicians in the meeting, physician leaders, completed the survey. I, myself, completed this survey. It was a significant task, and required at least 1 to 1.5 hours to complete. The draft of the final report is due in September 2011.

Unfortunately, there is not much to report in terms of progress with Expedited Care. I met recently with an Advisor to the Minister of Health. Our plan to improve care and save money was received quite well. Some help was promised in pushing this on to the Ministry of Labour. However, I feel that WSIB has its own agenda and we are not even on their radar.

This being an election year may also complicate any government pressures. I feel we should have a candid discussion about our options at the AGM and decide where we should go with this.