Alberta Health phone call codes are some of the most underused billing codes for physicians. In this post, we’re going to review how to correctly bill the AHCIP phone codes and the restrictions on their use. Knowing how to bill the phone call codes eligible to your practice, and implementing a system to ensure you capture those codes, is a key part of optimizing your billings. This post includes the general rules for Alberta Health billing codes and a breakdown of the codes grouped by codes for asking advice from physicians, codes for giving advice to physicians, nurse practitioners, or midwives, codes for giving advice to other healthcare professionals, and codes for phone calls made to patients.
You can find our related post on virtual care billing codes here: https://statgo.ca/blog/alberta-virtual-care-billing-codes-cheat-sheet/
General Rules
Service requirement thresholds for use of codes: Phone codes 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 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 intent of these codes is to cover advice of a physician more experienced in treating the particular problem in question, and that the referring physician intends to continue to care for the patient.
Limitations of code use: Phone codes may not be claimed for situations where the purpose of the call is to:
arrange for transfer of care that occurs within 24 hours unless the patient was transferred to an outside facility and advice was given on management of that patient prior to transfer
arrange for an expedited consultation or procedure within 24 hours
arrange for laboratory or diagnostic investigations
discuss or inform the referring physician of results of diagnostic investigations.
Documentation: As per the threshold requirements above, documentation must be recorded by both the referring physician and the consultant in their respective records.
Telehealth videoconferences: These may only be claimed when all participants are participating in the videoconference from regional telehealth facilities. See our post here for alternatives in billing virtual care services.
Video conference privacy requirements: If using a video conference, your system must meet certain requirements. To ensure the claim is eligible, you must use secure videoconference system that is in compliance with the CPSA guidelines on secure electronic communication and a Privacy Impact Assessment for this service accepted by the Office of the Privacy Commissioner of Alberta.
Who initiates the call: Phone billing codes for giving advice (HSC 03.01LJ, 03.01LK, 03.01LL) can only be claimed when the call is initiated by a referring physician, nurse practitioner, midwife or podiatric surgeon.
Restrictions if subsequently seeing patient: When giving advice, 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.
Referring physician: The PRACID of the referring physician must be entered into the claim in order to receive payment for these services.
Daily Maximums: A maximum of two (any combination of HSC 03.01LJ, 03.01LK, 03.01LL) claims may be claimed per patient, per physician, per day.
Other registered health professionals include: Paramedics – pre hospital patch, Mobile Integrated Healthcare Unit paramedic, 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. 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.
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.
Advice to Midwives: may be claimed if the midwife is in independent practice or working at a midwifery center.
Advice to long term care or active treatment facility workers: Claims may only be submitted when the physician is outside the facility where the patient is located.
Who initiates the call: Billing codes 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. For 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.
Daily Maximums: A maximum of two (any combination of HSC 03.01NG, 03.01NH, 03.01NI) claims may be claimed per patient, per physician, per day.
03.01LG
Description: Physician to physician telephone or videoconference consultation, referring physician, weekdays 0700-1700.
Value: $33.28
Tips:
03.01LH
Description: Physician to physician telephone or videoconference consultation, referring physician, weekdays 1700-2200, weekends & stat holidays 0700 to 2200.
Value: $36.45
Tips:
03.01LI
Description: Physician to physician telephone or videoconference consultation, referring physician, any day 2200-0700.
Value: $40.69
Tips:
03.01LJ
Description: Physician, nurse practitioner, midwife or podiatric surgeon to physician or videoconference consultation, consultant, weekdays 0700 to 1700 hours
Value: $77.74
Tips:
Available to all physicians; however, it is expected that the purpose of the call will be to seek the advice of a physician more experienced in treating the particular problem in question
No applicable modifiers
A maximum of two (any combination of HSC 03.01LJ, 03.01LK, 03.01LL) claims may be claimed per patient, per physician, per day.
03.01LK
Description: Physician, nurse practitioner, midwife or podiatric surgeon to physician or videoconference consultation, consultant, weekdays 1700 to 2200 hours, weekends and statutory holidays 0700 to 2200 hours
Value: $115.07
Tips:
Available to all physicians; however, it is expected that the purpose of the call will be to seek the advice of a physician more experienced in treating the particular problem in question
No applicable modifiers
A maximum of two (any combination of HSC 03.01LJ, 03.01LK, 03.01LL) claims may be claimed per patient, per physician, per day.
Description: Physician, nurse practitioner, midwife or podiatric surgeon to physician or videoconference consultation, consultant, any day 2200 to 0700 hours
Value: $135.85
Tips:
Description: Patient care advice to paramedic – pre hospital patch, Mobile Integrated Healthcare Unit paramedic, 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
Value: $17.43
Tips:
Description: Patient care advice to paramedic – pre hospital patch, Mobile Integrated Healthcare Unit paramedic, 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
Value: $20.60
Tips:
Description: Patient care advice to paramedic – pre hospital patch, Mobile Integrated Healthcare Unit paramedic, 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
Value: $23.77
Tips:
Description: Physician telephone call directly to patient, to discuss patient management/diagnostic test results
Value: $20.00
Tips:
The following is a table / cheat sheet for virtual care billing codes in Alberta
| Code | Type | Description | Type of Day | Value | Billing Restrictions |
| 03.01LG | Asking Advice | Referring physician: Physician to physician telephone or videoconference consultation | Weekdays 0700-1700 | $33.28 | Maximum 2 per patient per billing code type per day. |
| 03.01LH | Asking Advice | Referring physician: Physician to physician telephone or videoconference consultation | Evenings 1700-2200 and Weekends/Holidays 0700-2200 | $36.45 | Maximum 2 per patient per billing code type per day. |
| 03.01LI | Asking Advice | Referring physician: Physician to physician telephone or videoconference consultation | Nights 2200-0700 | $40.69 | Maximum 2 per patient per billing code type per day. |
| 03.01LJ | Giving Advice to Physician, NP or Midwife | Consulting Physician: Phone or Videoconference consultation to physician, nurse practitioner, or midwife | Weekdays 0700-1700 | $77.74 | Maximum 2 per patient per billing code type per day. |
| 03.01LK | Giving Advice to Physician, NP or Midwife | Consulting Physician: Phone or Videoconference consultation to physician, nurse practitioner, or midwife | Evenings 1700-2200 and Weekends/Holidays 0700-2200 | $115.07 | Maximum 2 per patient per billing code type per day. |
| 03.01LL | Giving Advice to Physician, NP or Midwife | Consulting Physician: Phone or Videoconference consultation to physician, nurse practitioner, or midwife | Nights 2200-0700 | $135.81 | Maximum 2 per patient per billing code type per day. |
| 03.01NG | Giving Advice to Other Health Professional | Consulting Physician: Phone or Videoconference consultation to other health practitioner | Weekdays 0700-1700 | $17.43 | Maximum 2 per patient per billing code type per day. |
| 03.01NH | Giving Advice to Other Health Professional | Consulting Physician: Phone or Videoconference consultation to other health practitioner | Evenings 1700-2200 and Weekends/Holidays 0700-2200 | $20.60 | Maximum 2 per patient per billing code type per day. |
| 03.01NI | Giving Advice to Other Health Professional | Consulting Physician: Phone or Videoconference consultation to other health practitioner | Nights 2200-0700 | $23.77 | Maximum 2 per patient per billing code type per day. |
| 03.05JR | Call to Patient | Phone call to patient to discuss patient management/diagnostic test results | N/A | $20.00 | Maximum 14 per week |
Phone billing codes are an important part of optimizing your billing in Alberta. With remote care, phone codes, along with virtual care codes, will be important for physicians to understand and use correctly. Documentation is critical both to billing correctly, and ensuring you capture all your potential phone billing codes. Having a robust documentation system, along with diligent record habits, will help you earn more. If you have any questions regarding phone codes or how to bill them, please contact us.