Update: Since this post, the Alberta government has made COVID-19 and virtual billing codes permanent. You can view our post on that here. You can also read our post on tips for billing virtual billing codes here

COVID-19 is having major impacts on the physicians and healthcare system. The Alberta government has introduced new medical billing codes for virtual consultations, available to physicians during the current COVID-19 epidemic environment. The updates were provided in two bulletins: MED221, MED222, MED228 and GEN126. In this post, we have a summary of the new codes.

You can also check out our post on Tips for billing COVID-19 and AHCIP Virtual Codes.

Visit services

Health Service Code 03.01AD – Telephone advice to a patient or their agent (agent as defined in the Personal Directives Act) during a viral epidemic.

03.01AD can be used to bill for providing advice via telephone, email, and videoconference including virtual care. The code is not limited to patients with diagnosed or suspected COVID-19. There is no cap on the number of claims a physician can submit. However, 03.01AD can only be claimed once per patient, per physician, per day. The code can be billed from all facilities, including office, home, and hospital. The daily cap effective March 31, 2020 will not apply to 03.01AD

you are using email and videoconference systems, they must be in compliance with the CPSA guidelines on secure electronic communication and when the physician/clinic has submitted a Privacy Impact Assessment for this service acceptable to the Office of the Privacy Commissioner of Alberta. This includes receiving patient consent if videoconference is used. Regular landlines and cell phones can be used to provide advice.

Example: A GP provides patient care advice via telephone related to a cough (total duration 5 minutes). Claim 03.01AD -$20.

HSC 03.03CV – Assessments provided by General Practitioners(GP) and Specialists via telephone or secure videoconference.

This code applies to a limited assessment of a patient’s condition requiring a history related to the presenting problems, appropriate records, and advice to the patient. The assessment must last a minimum of 10 minutes.

Example: An Internal Medicine Specialist completes a visit via telephone to discuss medication management (total duration 20 minutes). Claim 03.03CV -$55.64.

HSC 03.03FV – Follow up assessments (visits), for referred patients only, provided by specialists via telephone or secure videoconference.

This code applies to a limited assessment of a patient’s condition requiring a history related to the presenting problems, appropriate records, and advice to the patient and can only be claimed by specialists that are eligible to claim 03.03F.

Example: A Cardiologist completes a follow-up visit via telephone regarding complex coronary artery disease (total duration 20 minutes) Claim 03.03FV -$103.25.

Consultation services

HSC 03.08CV – Comprehensive consultations provided via telephone or secure videoconference.

This code applies to a comprehensive assessment of a patient’s condition requiring a complete history, appropriate records, advice to the patient, and a written report to the referring physician or eligible practitioner.

Example: A Neurologist completes a comprehensive consultation via videoconference for a referred patient (total duration 40 minutes). Claim 03.08CV -$197.86.

HSC 08.19CX – Comprehensive psychiatric consultation provided via telephone or secure videoconference.

This code applies to Psychiatrists and Generalists of Mental Health who complete a comprehensive assessment of a patient’s condition requiring a complete history, appropriate records, advice to the patient, and a written report to the referring physician or eligible practitioner.

Example: A Psychiatrist provides a consultation service (duration 50minutes).08.19CX = $242.53.

Mental health services

HSC 08.19CV – Psychotherapy and other psychiatric services (such as group therapy) provided via telephone or secure videoconference by a Psychiatrist or a Generalist of Mental Health.

This code applies to Psychiatrists and Generalists of Mental Health who provide psychiatric treatment (including medical psychotherapy and medication prescription), psychiatric reassessment, patient education and/or psychiatric counseling.

Example: A Generalist of Mental Health provides 30 minutes of counselling via telephone to a patient.Claim 2 calls of 08.19CV -$88.02.

HSC 08.19CW – Psychotherapy and other psychiatric services (such as group therapy) provided via telephone or secure videoconference by a GP and Pediatrician.

This code applies to GPs and Pediatricians who provide scheduled psychiatric treatment (including medical psychotherapy and medication prescription), psychiatric reassessment, patient education and/or psychiatric counseling.

HSC 08.19CW is paid based on full 15-minute units and can only be claimed for scheduled appointments and for patients with an established history requiring this service.

Example: A GP provides a scheduled 38 minutes of psychotherapy via videoconference to a patient.Claim 2 calls of 08.19CW –$95.08.

08.19CX – Formal major psychiatric consultation via telephone or secure videoconference, first full 30 minutes or major portion thereof for the first call when only one call is claimed

Psychiatric consultations provided by telephone or secure videoconference for patients referred by a registered: occupational therapist, psychologist, community based psychiatric nurse, social worker or speech language pathologist may be claimed using fee code 08.19CX

Chronic Pain Management / Palliative Care

08.19CW – Telephone or secure videoconference with a patient for scheduled psychiatric treatment (including medical psychotherapy and medication prescription), psychiatric reassessment, patient education and/or psychiatric counseling, including group therapy by general practitioners or pediatricians, per full 15 minutes.

Palliative care is defined as care given to a patient with a terminal disease such as cancer, AIDS, or advanced neurologic disease, and involves active ongoing multi-disciplinary team care

Chronic pain and palliative care visits provided by telephone or secure videoconference may be claimed using fee code 08.19CW

Nephrology and Critical Care Medicine HSCs

03.03FV – Repeat office visit or scheduled outpatient visit, referred cases only via telephone or secure videoconference

Follow-up care for referred patients provided by a nephrologist or a critical care medicine specialist may be claimed using fee code 03.03FV

COVID Billing Process for non-Residents of Canada

Non-entitled non-resident of Canada – For the COVID-19 diagnosis and/or treatment of COVID-19 for a non-entitled non-resident of Canada

Enter the appropriate Health Service Code from the Procedure List in the Schedule of Medical Benefits (SOMB)

The COVID-19 diagnostic code must be identified in the claim (diagnostic code 079.82 or 079.8)

Attach a person data segment and enter the personal information collected from the patient, including their name and the address in Alberta where the patient is staying

Prior to submitting a claim under the COVID-19 billing process, physicians must verify insurance eligibility to determine that the patient is a non-entitled non-resident of Canada

Appropriate diagnostic codes

To help with monitoring, please use ICD Code 079.82 or 079.8 (if restricted by claim submitter software) on all SOMB claims related to COVID-19 even if the patient is not diagnosed with COVID-19 but consulted a physician for symptoms.

Alberta government bulletins

MED 211 Amended – Telephone/Email/Videoconference Advice during COVID-19

https://www.alberta.ca/assets/documents/health-ahcip-bulletin-med-221.pdf

MED 222 – Additional Virtual Care Codes for physicians during COVID-19 epidemic

https://www.alberta.ca/assets/documents/health-ahcip-bulletin-med-222.pdf

MED 228 – Changes to the Schedule of Medical Benefits

https://open.alberta.ca/dataset/58a224a2-0fed-4b1e-b8d5-9f6cf70450c6/resource/9402f265-fca2-4439-b6e8-d6b583555757/download/health-ahcip-bulletin-covid-med-228-changes-to-somb.pdf

GEN126 – COVID-19 Billing Process for nonresidents of Canada

https://www.alberta.ca/assets/documents/health-ahcip-bulletin-med-221.pdf

Other interesting articles

5 Tips to improve your AHCIP medical billing

https://statgo.ca/blog/5-tips-to-improve-your-ahcip-medical-billing/

Tips for billing COVID-19 and AHCIP Virtual Codes

https://statgo.ca/blog/tips-for-billing-covid-19-and-ahcip-virtual-codes/

Virtual medical billing codes and COVID-19

https://statgo.ca/blog/covid19

Alberta government schedule of benefit changes

https://statgo.ca/blog/alberta-government-schedule-of-benefit-changes

How do you compare?

https://statgo.ca/blog/how-do-you-compare

Improving your billings

https://statgo.ca/blog/improving-your-billings