To help accelerate the COVID-19 vaccine roll-out, the Alberta Government has asked Alberta physicians to help in the vaccine campaign. As of March 15, 2021, two new vaccine billing codes have been added to the AHCIP Schedule of Medical Benefits which allow physicians to bill for the administration of vaccines to patients. In this post, we’ll review how to bill for administering COVID-19 vaccines, what’s included and excluded in those billing codes, and which diagnostic codes are appropriate when submitting COVID vaccine billing codes.
These billing codes and related instructions were released in AHCIP bulletins MED 242 and MED 243.
AHCIP released two new vaccine codes for Alberta physicians administering the COVID-19 vaccine.
HSC 13.59V – Immunization and administration of COVID-10 vaccine – $25
This COVID-19 billing codes reimburses physicians $25 for the immunization and administration of the COVID-19 vaccine for appointments that take 10 minutes or less. This billing code can be billed by physicians if they directly administer the vaccine or if the vaccine is administered by an eligible health care provider (example: nurse) under the direct supervision of a physician and the physician is onsite and available immediately.
HSC 13.59V – Prolonged COVID-19 vaccination – $20
This COVID-19 billing code may be claimed in addition to the 13.59V if the physician spends more than 10 minutes directly with the patient during the vaccine appointment. It is important to note this does not include the post-vaccination monitoring time or time spent on indirect patient care such as charting.
Billing code 13.59V (Immunization and administration of COVID-19 vaccine) includes the following physician services:
Determination of appropriate candidacy of the patient for the vaccination. This includes but not limited to reviewing patient records in Alberta Netcare or another appropriate patient record system to ensure that vaccine dose being provided is appropriately sequenced.
General discussion with the patient, parent, guardian and or agent as defined by the Personal Directives Act regarding the benefits and risks associated with the vaccine
Obtaining consent.
Administration of a single dose of the vaccine.
Monitoring the patient for any immediate post-vaccination adverse effects.
Updating the patient’s immunization record on the Immunization Direct Submission Mechanism.
Appropriate record and scheduling the second/subsequent vaccine date as appropriate in the patient’s record and reasonably follow-up with the patient to ensure the second dose is administered.
The additional COVID-19 AHCIP billing code 13.59VA (Prolonged COVID-19 vaccination – physician time only, greater than 10 minutes) includes the above physician services, applied where the physician directly spends more than 10 minutes with the patient.
13.59V and 13.59VA have the following guidelines and restrictions.
Physicians are required to review Alberta Netcare or another appropriate patient record system to ensure that the vaccine dose being provided is appropriately sequenced. The patient’s record must provide a detailed description of the service and must include the vaccine administered and the name of the provider who administered the vaccine.
The codes may only be claimed if the initial purpose of the visit is to administer the COVID-19 vaccine. 13.59V and 13.59VA may not be claimed in addition to any other service except HSC 13.59V during the same encounter for the same patient. See details below on how bill if the COVID-19 vaccine if the patient visit included another medical service.
If claiming the additional billing code 13.59VA, the patient’s record must provide a detailed description of the service and must include documentation of any counselling provided, documentation of any adverse reactions to the vaccine, and start and stop times for all services personally rendered by the physician.
When assessing if the length of the patient vaccine appointment is greater than 10 minutes, you cannot include time for post-vaccination-monitoring or time spent on indirect patient care such as charting.
As with all AHCIP billing codes, concurrent time for overlapping services may not be claimed.
The COVID-19 vaccine codes 13.59V and 13.59VA may only be claimed if the initial purpose of the visit is to administer the COVID-19 vaccine. 13.59V and 13.59VA may not be claimed on the same day as a visit service (except 13.59VA). If the COVID-19 vaccine is administered as part of a scheduled visit or any other service that was unrelated to the vaccine, the physician may bill the appropriate service and 13.59A with diagnostic code 079.82 or 079.8.
The most appropriate DI codes outlined by Alberta Health for use with the administration of COVID-19 vaccines are:
079.82 – SARS – associated coronavirus
079.8 – Other specified viral and chlamydial infections
Example 1:
A physician administers the COVID-19 vaccine to a patient who came for a vaccine appointment. The physician spends 8 minutes directly with a patient and 5 minutes updating records and charting for a total of 13 minutes related to vaccine services. The patient stays an additional 15 minutes in the clinic waiting area for post-vaccine monitoring. The correct AHCIP billing codes are:
13.59V – $25
NOTE: The physician cannot bill the additional COVID-19 vaccine code 13.59AV (Prolonged COVID-19 vaccination over 10 minutes) as the time billed can only reflect time directly spent with the patient and not time on indirect patient care such as charting.
Example 2:
A physician administers the COVID-19 vaccine to a patient who came for a vaccine appointment. The physician spends 12 minutes directly with a patient and 5 minutes updating records and charting for a total of 18 minutes related to vaccine services. The patient stays an additional 15 minutes in the clinic waiting area for post-vaccine monitoring. The correct AHCIP billing codes are:
13.59V – $25
13.59AV – $20
NOTE: The physician can bill the additional COVID-19 vaccine code 13.59AV (Prolonged COVID-19 vaccination over 10 minutes) as the time spent directly with the patient exceeds 10 minutes.
Example 3:
A patient books an appointment with a physician for a medical issue unrelated to the COVID vaccine. During the appointment, the physician determines the patient is eligible for the COVID-19 vaccine and then administers the vaccine. The physician spends 20 minutes with a patient and 5 minutes updating records and charting. The patient stays an additional 15 minutes in the clinic waiting area for post-vaccine monitoring. The correct AHCIP billing codes are:
03.03A – Limited assessment of a patient’s condition requiring a history related to the presenting problems
13.59A (DI code 079.82) – $10.14
The Alberta Health COVID-19 vaccine codes are relatively straight forward so long as you follow the guidelines for what services do or do not qualify as a prolonged COVID-19 vaccination visit. If you have any question, please let us know.