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 physicians who specialize in general surgery.
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.
Click here for changes affecting all Alberta physicians.
Note: all new changes are marked with ***.
General Surgery
| Fee Code | Description |
|---|---|
| GR 6.9.7 | The section on multiple procedures does not apply. |
Note: The section on multiple procedures does not apply when the lesser or secondary procedure is:
a. A fracture that is otherwise provided for in this Schedule.
b. A dislocation
c. A procedure considered to be part of an inclusive benefit, or
d. A secondary procedure that is paid in full as an additional item or as an interpretation of a diagnostic test as a listed benefit in the Schedule.
e. A procedure listed in the following table which may be claimed at 100% when performed as a second or subsequent procedure by any physician, regardless of whether the procedures are performed by one or more physicians and regardless of whether additional incisions are required to perform the procedure. This does not apply to anesthetic services; refer to GR 12.4.9.
***Remove HSC 65.9 A
f. A procedure listed in the following table that may be claimed at 100% when performed as a second or subsequent procedure through a different incision by any physician, regardless of whether the procedures are performed by one or more physicians. This does not apply to anesthetic services; refer to GR 12.4.
g. Procedures in different groups in the following table may be claimed at 100% each when performed at the same operative encounter. For example, procedures listed in group B may be claimed at 100% when performed at the same operative encounter as procedures listed in group A. Two procedures from the same group will continue to be paid at 100% and 75% for second and subsequent procedures. This does not apply to anesthetic services; refer to GR 12.4.
***Remove HSCs 56.51A and 56.93
Group A
Group B
Group C
***Add HSCs 56.93F and 65.9 E
Group D
| 01.12 | ***Deleted. Will be replaced by HSC 01.12B (see below) and 01.12 will become a heading. |
| 01.12B | ***HSC 01.12B replaces HSC 01.12 which has been deleted in order to make the appropriate headings. ***01.12 Other nonoperative esophagoscopy. 01.12A Functional endoscopic esophageal study. ***01.12B Other nonoperative esophagoscopy, rigid. |
| 01.24BA | Flexible proctosigmoidoscopy for screening of patients considered to be of high risk for colon cancer due to a family history of Familial Adenomatous Polyposis (FAP). |
Guidelines for 01.24BA
1. HSCs 57.13A, 57.21A, 57.21B, ***57.21C, and 58.99D may be claimed in addition.
2. Benefit includes biopsies.
3. Benefit includes the removal of diminutive polyps that are 5mm or less in size.
4. May be claimed once every year beginning at the age of 10.
***Add HSC 57.21C
| 01.24BB | Flexible proctosigmoidoscopy for screening of patients who are considered to be of average risk for colon cancer. |
Guidelines for 01.24BB
1. HSCs 57.13A, 57.21A, 57.21B, ***57.21C, and 58.99D may be claimed in addition.
2. Benefit includes biopsies.
3. Benefit includes the removal of diminutive polyps that are 5mm or less in size.
4. Average risk is defined as an individual who is asymptomatic and aged 50 to 74 years.
5. May be claimed once every 5 years.
***Add HSC 57.21C
| 13.99GA | ***Amend Note 6 to read as follows: Trauma assessment, multiple trauma, severely injured patient. NOTE: 6. Following the ***seventh day of trauma care, the appropriate level of hospital care should be claimed using HSC 03.03D. |
| 52.2 | Regional lymph node excision That for TB etc NOTE: ***May not be claimed in addition to HSCs 55.8 B, 55.9 AA and 63.69A. Add HSCs 55.8 B and 55.9 AA. |
| 52.49E | Radical excision of other lymph nodes ***Deleted. |
| 53.53A | ***Spleen – rupture with repair. ***NOTE: May not be claimed for incidental repair. |
| 54.21A | Biopsy of esophagus via rigid esophagoscopy ***Deleted. |
| 54.6 | Esophagomyotomy. NOTE: May not be claimed with 54.76A, 65.7B, 65.7C, 65.8B or 65.8C. *** Remove HSC 65.7C from note. |
| 55.8 B | Radical sub-total. NOTE: 1. May be claimed in addition to HSC 66.83. ***2. May not be claimed in addition to HSCs 52.2, 56.2, 57.7, and 66.3 A. |
| 55.8 C | Radical sub-total with splenectomy ***Deleted. |
| 55.8 D | Radical sub-total with splenectomy and partial pancreatectomy ***Deleted. |
| 55.9 AA | Total gastrectomy for malignancy. NOTE: May not be claimed with HSCs ***52.2, 52.43A, 55.9 A, ***56.2, and 57.7, ***and 66.3 A. |
| 55.9 B | With elective splenectomy. ***Deleted. |
| 55.9 C | With elective splenectomy and partial pancreatectomy. ***Deleted. |
| 56.2 | Gastroenterostomy (without gastrectomy). NOTE: May not be claimed with HSCs ***55.8 B, 55.9 AA, 64.3, 64.43A, 64.49A or 64.7. |
| 56.4 A | Gastrectomy revision with or without resection. *** NOTE: May not be claimed in addition to HSC 66.4 A. |
| 56.51A | Closure of perforated gastric ulcer ***Deleted; included in HSC 56.39A. |
| 56.93 | Gastric partitioning. That for obesity ***Deleted; to be replaced by HSC 56.93F. |
| ***56.93F | ***Gastric partitioning for obesity (56.93F Placement of gastric band including port placement). |
| 56.93D | Removal of gastric band. NOTE: May not be claimed in addition to *** HSCs 56.93E, 66.4 A, and 66.83. |
| 56.93E | Port revision or replacement. ***NOTE: May not be claimed in addition to HSC 56.93D. |
| 57.7 | Small to small intestinal anastomosis. NOTE: 1. May be claimed for ileostomy closure and/or stricturoplasty. 2. May not be claimed in addition to ***HSCs 55.8 B, 55.9 AA, 57.42A or 63.69A. |
| 57.42A | Small bowel resection. NOTE: 1. May only be claimed with HSC 57.59A when two anastomoses are performed. 2. May only be claimed with HSC 60.52B when two discontinuous areas are resected and two anastomoses are performed. 3. May not be claimed in addition to ***HSCs 57.7 or 63.12B. |
| 65.01A | Repair of inguinal hernia – with or without incarceration, obstruction or strangulation. ***Deleted. |
| 65.7 C | Anti-reflux procedure That for recurrent esophagitis, following a previous repair. ***Deleted. – replaced by new HSC 65.9E. |
| 65.8 C | Anti-reflux procedure That for recurrent esophagitis, following a previous repair. ***Deleted. |
| 65.9 A | Strangulated hernia with resection ***Deleted. |
| ***65.9 E | ***Repair of diaphragmatic hernia, abdominal or thoracic approach, anti-reflux procedure That for recurrent esophagitis, following a previous repair Replaces HSCs 65.7 C and 65.8 C. |
| ***65.11A | ***Repair of inguinal hernia – with or without incarceration, obstruction or strangulation, includes the use of mesh if used Replaces HSC 65.01A. |
| 66.3 A | Omentectomy, for abdominal malignancy, additional benefit. NOTE: May be claimed in addition to the primary procedure performed, ***except for HSCs 55.8 B and 55.9 AA. |
| 66.83 | Laparoscopy Diagnostic, with or without biopsy. |
Guidelines for 66.83
1. May not be claimed in addition to other procedures if the laparoscopy is an integral part of the procedure with the exception of HSCs 62.12B, 81.09, 82.63 or 83.2 B, which may be claimed at 100%.
2. May be claimed in addition to HSCs 55.8 A, 55.8 B, 55.8 C, 55.8 D, 55.9 A, 55.99A, 55.9 B, 55.9 C, 64.43A, 64.49A.
3. ***May not be claimed in addition to HSC 56.93D.
| 67.01C | Renal exploration to include drainage of renal or peri-renal abscess. ***Deleted. |
| 01.12 | ***Deleted. Will be replaced by HSC 01.12B and 01.12 will become a heading. |
| 01.12B | ***HSC 01.12B replaces HSC 01.12 which has been deleted in order to make the appropriate headings. 01.12 Other nonoperative esophagoscopy. 01.12A Functional endoscopic esophageal study. 01.12B Other nonoperative esophagoscopy, rigid. |
| 01.24BA | Flexible proctosigmoidoscopy for screening of patients considered to be of high risk for colon cancer due to a family history of Familial Adenomatous Polyposis (FAP). |
Guidelines for 01.24BA
1. HSCs 57.13A, 57.21A, 57.21B, 57.21C, and 58.99D may be claimed in addition.
2. Benefit includes biopsies.
3. Benefit includes the removal of diminutive polyps that are 5mm or less in size.
4. May be claimed once every year beginning at the age of 10.
***Add HSC 57.21C
| 01.24BB | Flexible proctosigmoidoscopy for screening of patients who are considered to be of average risk for colon cancer. |
Guidelines for 01.24BB
1. HSCs 57.13A, 57.21A, 57.21B, 57.21C, and 58.99D may be claimed in addition.
2. Benefit includes biopsies.
3. Benefit includes the removal of diminutive polyps that are 5mm or less in size.
4. Average risk is defined as an individual who is asymptomatic and aged 50 to 74 years.
5. May be claimed once every 5 years.
***Add HSC 57.21C
| 03.01NL | Patient care advice to active treatment facility worker in relation to a patient receiving outpatient IV medication day treatment, any day 2200 to 0700 hours. |
Guidelines for 03.01NL
1. Active treatment facility worker may include registered: nurse, licensed practical nurse, occupational therapist, physiotherapist, speech language pathologist, social worker, pharmacist, psychologist, recreational therapist or respiratory therapist.
2. May only be claimed by ***hematology, infectious disease specialists, internal medicine and rheumatologists.
3. May only be claimed when the physician is outside the facility from where the patient is located.
4. May be claimed for advice given to the worker by telephone or other telecommunication means.
5. To be claimed using the Personal Health Number of the patient.
6. May only be claimed when the call is initiated by the health care worker.
7. A maximum of two (any combination of HSCs 03.01NJ, 03.01NK, 03.01NL) claims may be made per patient, per physician, per day.
8. Documentation of the communication must be recorded in their respective records.
| 03.03FA | ***Addition of MDON and NEUR to list of skill codes that are eligible to claim for the service. Prolonged repeat office or scheduled outpatient visit in a regional facility, referred cases only, full 15 minutes or portion thereof for the first call when only one call is claimed. |
Guidelines for 03.03FA
1. May only be claimed in addition to HSC 03.03F when the 03.03F exceeds 30 minutes.
2. May only be claimed by pediatrics (including subspecialties) and clinical immunology and allergy for patients 18 years of age and under, or by cardiology, endocrinology/metabolism, gastroenterology, infectious diseases, internal medicine, hematology, medical genetics, ***medical oncology, neurology, physiatry, respiratory medicine, rheumatology, urology and vascular surgery (no age restriction).
| ***03.39 | ***Other nonoperative measurements and examinations. (see below). |
| ***03.39A | ***24-hour ambulatory blood pressure monitoring (ABPM), interpretation NOTE: May only be claimed by internal medicine specialists. |
| ***03.39B | ***24-hour ambulatory blood pressure monitoring (ABPM), technical NOTE: May only be claimed by internal medicine specialists. |
| 03.08I | ***Addition of skill CARD, CLIM, and MDON descriptions in the list of eligible providers. Prolonged cardiology, clinical immunology, endocrinology/ metabolism, gastroenterology, hematology, infectious diseases, internal medicine, nephrology, physiatry, medical oncology, neurology, respiratory medicine or rheumatology consultation or visit, full 15 minutes or major portion thereof for the first call when only one call is claimed. |
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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