AHCIP has updated and released a new “Schedule of Medical Benefits,” effective as of November 1, 2018. The following guide is a quick reference to new changes that affect all Alberta physicians. For specific speciality changes, please find the appropriate link below.
Please note that the new Alberta fee codes are automatically available on Dr.Bill, they will appear on any claim with a ‘Date of Service’, on or after November 1st. If the ‘Date of Service’ is set before November 1st, it will show the old code along with its expiry date.
Any claims that are have already been submitted to AHCIP with the old fees but after November 1st, will come back as adjustments and our billing team will automatically handle them for you.
Note: all new changes are marked with ***.
All Physicians
| Fee Code | Description |
|---|---|
| 03.01LJ | Physician, ***nurse practitioner, midwife or podiatric surgeon to physician telephone or telehealth videoconference or secure videoconference consultation, consultant, weekdays 0700 to 1700 hours. |
| 03.01LK | Physician, ***nurse practitioner, midwife or podiatric surgeon to physician telephone or telehealth videoconference or secure videoconference consultation, consultant, weekdays 1700 to 2200 hours, weekends and statutory holidays 0700 to 2200 hours. |
| 03.01LL | Physician, ***nurse practitioner, midwife or podiatric surgeon to physician telephone or telehealth videoconference or secure videoconference consultation, consultant, any day 2200 to 0700 hours. |
Billing Tip: HSCs 03.01LJ, 03.01LK, 03.01LL are only to be used when the consulting physician is unfamiliar with the patient and in order to provide advice, the consulting physician must complete a history or assessment of the patient.
If the consulting physician already has a relationship established with the patient, then bill either HSC 03.01NG, 03.01NH, 03.01NI (see next section).
Guidelines for HSCs 03.01LJ, 03.01LK, 03.01LL
1. They can only be claimed when initiated by the referring physician, ***nurse practitioner, midwife or podiatric surgeon.
2. The consultant may not claim a major consultation or procedure for the same patient for the same condition within 24 hours unless the patient was transferred from an outside facility and advice was given on management of that patient prior to transfer.
3. It can only be claimed when the consultant has provided an opinion and recommendations for patient treatment as well as management after reviewing pertinent family/patient history and history of the presenting complaint as well as discussion of the patient’s condition and management after reviewing laboratory and other data where indicated. The purpose of the call should be for advice from another physician, with more experienced in treating the particular problem in question, and that the referring physician, ***nurse practitioner, midwife or podiatric surgeon intends to continue to care for the patient.
4. These cannot be claimed when the purpose of the call is to:
– arrange for an expedited consultation or procedure within 24 hours (except when the conditions in note 2 are met).
– arrange for laboratory or diagnostic investigations
– discuss or inform the referring physician or podiatric surgeon of results of diagnostic investigations.
5. A maximum of two (any combination of HSC 03.01LJ, 03.01LK, 03.01LL) claims may be claimed per patient, per physician, per day.
6. Documentation must be recorded by both the referring physician, ***nurse practitioner, midwife or the podiatric surgeon and the consultant in their respective records.
7. Telehealth videoconferences may only be claimed when all participants are participating in the videoconference from regional telehealth facilities.
8. Claims for secure videoconference may only be claimed when the service is provided using a secure videoconference system that is in compliance with the CPSA guidelines on secure electronic communication and when the physician/clinic has submitted a Privacy Impact Assessment for this service accepted by the Office of the Privacy Commissioner of Alberta.
9. ***Advice to nurse practitioners may only be claimed if the nurse practitioner is in autonomous practice or working at a nursing station where no physician is present.
10. ***Advice to midwives may be claimed if the midwife is in independent practice or working at a midwifery center.
| 03.01NG | Patient care advice to paramedic – pre hospital patch, assisted living/designated assisted living and lodge staff, active treatment facility worker for hospital in-patient, long term care worker for patients in a long term care facility, nurse practitioner, hospice worker, home care worker, ***midwife or public health nurse weekdays 0700 to 1700 hours, provided via telephone or other telecommunication methods, in relation to the care and treatment of a patient. |
| 03.01NH | Patient care advice to paramedic – pre hospital patch, assisted living/designated assisted living and lodge staff, active treatment facility worker for hospital in-patient, long term care worker for patients in a long term care facility, nurse practitioner, hospice worker, home care worker, ***midwife or public health nurse weekdays 1700 to 2200 hours, weekends and statutory holidays, 0700 to 2200 hours, provided via telephone or other telecommunication methods, in relation to the care and treatment of a patient. |
| 03.01NI | Patient care advice to paramedic – pre-hospital patch, assisted living/designated assisted living and lodge staff, active treatment facility worker for hospital in-patient, long term care worker for patients in a long-term care facility, nurse practitioner, hospice worker, home care worker, ***midwife or public health nurse any day 2200 to 0700 hours, provided via telephone or other telecommunication methods, in relation to the care and treatment of a patient. |
Guidelines for HSCs 03.01NG, 03.01NH and 03.01NI
1. Active treatment facility worker may include registered: nurse, licensed practical nurse, ***midwife, occupational therapist, physiotherapist, speech language pathologist, social worker, pharmacist, psychologist, recreational therapist or respiratory therapist.
2. Long term care worker/hospice worker may include registered: nurse, licensed practical nurse, occupational therapist, physiotherapist, speech language pathologist, social worker, pharmacist, psychologist or recreational therapist.
3. Advice to nurse practitioners may only be claimed if the nurse practitioner is in independent autonomous practice or working at a nursing station where no physician is present. Advice to a public health nurse may only be claimed if the public health nurse is employed by AHS and working in an AHS health unit.
4. ***Advice to midwives may be claimed if the midwife is in independent practice or working at a midwifery center.
5. In the case of long-term care or active treatment facility worker, claims may only be submitted when the physician is outside the facility where the patient is located.
6. May be claimed for advice given to ***midwife, hospice worker, home care worker or public health nurse in person as well as advice by telephone or other telecommunication methods.
7. HSCs 03.01NG, 03.01NH and 03.01NI are to be claimed using the Personal Health Number of the patient.
8. May only be claimed when the call is initiated by the long-term care worker, assisted living/designated assisted living or lodge staff member, active treatment facility worker, home care worker, nurse practitioner, hospice worker, ***midwife, public health nurse or paramedic.
9. In the case of a long-term care or hospice patient the call may be initiated by the physician if it is in response to receipt of diagnostic or other information that would affect the patient’s treatment plan.
10. May be claimed in addition to visits or other services provided on the same day, by the same physician.
11. A maximum of two (any combination of HSC 03.01NG, 03.01NH, 03.01NI) claims may be made per patient, per physician, per day.
12. Documentation of the communication must be recorded in their respective records.
| 03.01O | Physician or ***Nurse Practitioner to Physician secure E-Consultation, consultant. |
Guidelines for 03.01O
1. May only be claimed when both the referring and consulting physician or ***referring nurse practitioner and the consulting physician exchange communication using secure electronic communication that is in compliance with the CPSA guidelines on secure electronic communication and when the physician/ ***nurse practitioner/ clinic has submitted a Privacy Impact Assessment for this service acceptable to the Office of the Privacy Commissioner of Alberta.
2. This service is only eligible for payment if the consultant physician has provided an opinion/advice and/or recommendations for patient treatment and/or management within thirty (30) days from the date of the e-consultation request.
3. May only be claimed when initiated by the referring physician or ***nurse practitioner.
4. The consultant may not claim a major consultation, physician to physician phone call, or procedure for the same patient for the same condition within 24 hours of receiving the request for an e-consultation unless the patient was transferred from an outside facility and advice was given on management of that patient prior to transfer.
5. May only be claimed when the consultant has provided an opinion and recommendations for patient treatment as well as management after reviewing pertinent family/patient history, history of the presenting complaint as well as laboratory and other data where indicated. It is expected that the purpose of the communication will be to seek the advice of a physician more experienced in treating the particular problem in question, and that the referring physician or ***nurse practitioner intends to continue to care for the patient.
6. May not be claimed for situations where the purpose of the communication is to:
a. arrange for an expedited consultation or procedure within 24 hours (except when the conditions in note 4 are met).
b. arrange for laboratory or diagnostic investigations
c. discuss or inform the referring physician of results of diagnostic investigations.
7. Documentation of the request and advice given must be recorded by the consultant in their patient records.
8. This service may not be claimed for transfer of care alone.
9. ***Advice to nurse practitioners may only be claimed if the nurse practitioner is in autonomous practice or working in a nursing station where no physician is present.
| 03.01S | Physician to patient secure electronic communication. NOTE: 1. A maximum of ***fourteen 03.01S per calendar week per physician may be claimed. (changed from seven). |
| 03.01T | Physician to patient secure videoconference. NOTE: 1. A maximum of ***fourteen 03.01T per calendar week per physician may be claimed. (changed from seven). |
| 03.04Q | Post-surgical cancer surveillance examination. ***A referral is required for this service – cannot be self-referred. |
| 03.05JB | Formal, scheduled family conference relating to a specific patient, per 15 minutes or major portion thereof. NOTE: ***1. May not be claimed at the same encounter as a visit. (changed from a HSC 03.03A visit).2. May be claimed to a maximum of 12 calls or 3 hours per year (April 1 to March 31), per patient, per physician. |
| 03.05JR | Physician telephone call directly to patient, to discuss patient management/diagnostic test results. NOTE: 1. A maximum of ***14 telephone calls per physician, per calendar week may be claimed. (changed from 7). |
| ***03.7 BA | ***Medical Assistance in Dying – Determination Phase, full 15 minutes or major portion thereof for the first call when only one call is claimed. |
***Guidelines for 03.7 BA
1. May only be claimed for patient management for Medical Assistance in Dying.
2. Services related to the Determination Phase include:
a. Patient assessment for Medical Assistance in Dying;
b. Obtaining and reviewing medical records;
c. Reviewing but not waiting for lab and other diagnostic information, and
d. Completion of appropriate documents and forms.
3. All services must be provided in accordance with the CPSA standards for Medical Assistance in Dying.
4. May not be claimed in addition to a visit, consultation or assessment.
5. May not be claimed for travel time.
6. The total time spent during the Determination Phase may be calculated on a cumulative basis over the course of several hours or several days.
7. The patient’s record must include a detailed summary of all services provided including a summary of time spent per day per activity.
| ***03.7 BB | ***Medical Assistance in Dying – Action Phase, full 15 minutes or major portion thereof for the first call when only one call is claimed. |
***Guidelines for 03.7 BB
1. May only be claimed for patient management for Medical Assistance in Dying.
2. Services related to the Action Phase include:
a. Patient visit and assessment,
b. Pharmacy visit,
c. Patient care advice to pharmacist, providing physician and nurse practitioner,
d. Review and administration of medication,
e. Coordination of procedure, and
f. Completion of appropriate documents and forms.
3. All services must be provided in accordance with the CPSA standards for Medical Assistance in Dying.
4. May not be claimed in addition to a visit, consultation or assessment.
5. May not be claimed for travel time.
6. The total time spent during the Action Phase may be calculated on a cumulative basis over the course of several hours or several days.
7. The patient’s record must include a detailed summary of all services provided including a summary of time spent per day per activity.
| ***03.7 BC | ***Medical Assistance in Dying – Care After Death Phase, full 15 minutes or portion thereof for the first call when only one call is claimed. |
*** Guidelines for 03.7 BC
1. May only be claimed for patient management for Medical Assistance in Dying.
2. Services related to the Care After Death Phase include: a. Reporting of event;
b. Post event arrangements,
c. Completion of death certificate, and
d. Completion of appropriate documents and forms.
3. All services must be provided in accordance with the CPSA standards for Medical Assistance in Dying.
4. May not be claimed for travel time.
5. The total time spent during the Care After Death Phase may be calculated on a cumulative basis over the course of several hours or several days.
6. The patient’s record must include a detailed summary of all services provided including a summary of time spent per day per activity.
Please refer to the Schedule of Medical Benefits for complete details.
If you’re looking for another specialty, check out the links below:
General Practice
Internal Medicine
Pediatrics
Obstetrician Gynecologist
Radiology
Anesthesia
Cardiology
Critical Care
Emergency
Neurology
Ophthalmology
Otolaryngology
Gastroenterology
Plastic Surgery
“This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.”
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