In March 2020, the Alberta government introduced temporary virtual billing codes to allow physicians to continue providing care for patients (MED 222). Alberta Health created new categories of virtual care codes that allow physicians to bill for health care services provided over telephone or video conference. When first announced, the government restricted the use of these virtual billing codes to situations when a declaration of a public health emergency. With the pandemic ongoing, the government has now made these changes permanent (MED 231).
These changes will serve both patients and physicians, increasing access and options for health care services. The permanent change to the AHCIP billing codes will also offer physicians the opportunity to change the workflow of their practice, potentially offering different approaches to their medical practice and patient care.
In this post, we’ll review the latest updates to the AHCIP medical billing codes, covering the details of what physicians should know when recording their billings.
The following codes are now permanent. We’ve grouped them by category. For a detailed description of the all the COVID and virtual care codes, see our post on Virtual Medical Billing Codes and COVID-19.
Visit Services: Includes HSCs: 03.03CV and 03.08FV
Consultation Services: Includes HSCs: 03.08CV and 08.19CX
Mental Health Services: Includes HSCs: 08.19CV and 08.19CW and 08.19CX
Chronic Pain Management / Palliative Care HSCs: 08.19CW
Nephrology and Critical Care Medicine HSCs 03.03FV
Telephone Advice to patient HSC: 03.01AD
COVID Billing Process for non-Residents of Canada: Diagnostic code 079.82 or 079.8
Diagnostic code: Note physicians are requested to use the following diagnostic codes 079.82 (or 079.8 if 079.82 is not supported on your billing platform) on all SOMB claims related to COVID-19 even if the patient is not diagnosed with COVID-19 but consulted a physician for symptoms.
There are some rules and restrictions that physicians should keep in mind when submitted virtual care medical billing codes. Below we address popular questions regarding these billing codes:
What Visits and Consultations that can be billed?
Visits must be initiated by the patient (or their agent). This can be a referral or the patient requesting physician services. The physician cannot initiate the service. Consultations are considered initiated on the patient’s behalf by virtue of the consultation request. For all of these codes, the medical bulletins are explicit that the Physician must provide the service.
What Records to should I keep?
When billing COVID virtual care codes, it is important to keep appropriate the records. Here are the records that should be kept and how they should be submitted:
Location of service – The location of the service is the location of the physician at time of service.
Patient Records – Patient record must reflect a detailed summary of the service.
Time Records – Record start and stop time of the virtual visit in the patient record
Are there any restrictions on billing virtual care codes?
Yes. There are several restrictions when billing virtual codes:
Patient time only – Alberta Health has stated that only physician to patient time can be claimed, meaning if you choose to complete charting/referral letters after the patient visit/consultation appointment has concluded, you cannot claim this time.
Daily per patient Code Limit – One virtual visit per patient, per physician, per day may be claimed
Restrictions with other codes – Virtual codes cannot be billed with other virtual services or in-person services provided on the same day, by the same physician, for the same patient
Restrictions on premiums – Additional premiums, such as age modifiers, complex modifiers, after hours time premiums, prolonged codes, BCP and RRNP will not apply to virtual codes
Visits less than 10 minutes – Virtual services that are 10 minutes or less MUST be claimed using 03.01AD regardless if the service was regarding COVID-19
Restriction on TELES modifer – The telehealth modifier TELES, does NOT apply to the virtual codes.
Limits for general virus information – None of the above virtual codes may be claimed for providing general information on the virus
Do Virtual Care codes count towards the Daily Visit Caps?
No. These codes will NOT count towards the daily patient cap introduced on March 31, 2020. The AHCIP virtual care codes listed above do not count towards the daily patient limit cap. In addition, retroactive to March 31, 2020, Group therapy and teaching fee codes (03.05LB, 08.44A, 08.44B, 08.44C,08.44D) have been added to the list of services exempt from the daily patient visit cap
What about COVID Diagnostic Codes?
If the patient consults the physician about COVID-19 or discusses the virus at the same time as other medical services, you should add the DI code 079.8(2) to the claim for tracking purposes. Note these apply only to COVID-19 related care. Other services billed under the virtual care codes unrelated to COVID-19 should not include these diagnostic codes.
What Patient Consent do I need when providing virtual care in Alberta
If videoconference is used, consent is required from the patient. If by telephone, consent is not required.
And that’s the summary for the new AHCIP virtual billing codes. It will be interesting to see how virtual care evolves in Alberta. We expect to see more virtual care in the future, and with it, more changes to how physicians do their billing. If you have questions, connect with us know. We’re always happy to chat.