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 practice or internal medicine.
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 Practice
| 03.04J | Development, documentation and administration of a comprehensive annual care plan for a patient with complex needs. |
Guidelines for 03.04J
1. A maximum of 15 comprehensive annual care plans per physician per calendar week may be claimed.
2. May only be claimed by the most responsible primary care general practitioner ***who has an established relationship with the patient and where the physician intends to provide ongoing care and management of the patient.
3. May only be claimed once per patient per year and includes ongoing communication as required as well as re-evaluation and revision of the plan within a year.
4. May be claimed in addition to HSCs 03.03A, 03.03N or 03.04A.
5. Time spent on the preparation of the complex care plan may not be included in the time requirement for a complex modifier.
6. “Complex needs” means a patient with multiple complex health needs including chronic disease(s) and other complications. The patient must have at least two or more diagnoses from group A or one diagnosis from group A and one or more from group B in order to be eligible. Group A and Group B:
– Hypertensive Disease -Mental Health Issues
– Diabetes Mellitus -Obesity (Adult = BMI)
– Chronic Obstructive Pulmonary Disease 40 or greater Child
– Asthma = 97 percentile
– Heart Failure -Addictions
– Ischemic Heart Disease -Tobacco
– Chronic Renal Failure
7. “Care plan” means a single document that meets the following criteria:
a. Must be communicated through direct contact with the patient and/or the patient’s agent.
b. Must include clearly defined goals which are mutually agreed upon between the patient and/or the patient’s agent and the physician.
c. Must include a detailed review of the patient chart, current therapies, problem list and past medical history.
d. Must include any relevant information that may affect the patient’s health or treatment options, such as demographics (education, income, language) or lifestyle behaviors (addictions, exercise, sleep habits, etc.)
e. Must incorporate the patient’s values and personal health goals in the care plan, with respect to his or her complex needs.
f. Must outline expected outcomes as a result of this plan, including end-of-life issues when clinically appropriate.
g. Must identify other health care professionals that would be involved in the care of the patient and their expected roles.
h. Must include confirmation that the care plan has been communicated verbally and in writing to the patient and/or the patient’s agent.
i. Must be signed by both the physician and the patient or patient’s agent. ***The comprehensive annual care plan is only billable if the care plan form on record is signed by both the physician and the patient or patient’s agent.
j. ***The signed copy of the care plan form must be retained in the patient’s medical record.
| 03.05JR | Physician telephone call directly to patient, to discuss patient management/diagnostic test results. NOTE: 1. A maximum of ***14 telephone calls per physician, per calendar week may be claimed. (changed from 7). |
| ***13.99JA | ***Amend Note 7 and the Price List |
***13.99JA to read as follows:
Management of complex labour, per 15 minutes
NOTE: 7. A maximum of ***twelve 15-minute units may be claimed per patient per pregnancy.
CALL M15 V
1-12 For Each Call Pay Base At 100%
SURC EV Y Increase By 48.70
SURC NTAM Y Increase By 116.83
SURC NTPM Y Increase By 16.83
SURC WK Y Increase By 48.70
| ***91.01M | Closed reduction of fracture, radius and ulna displaced. ***Remove the UNDP (Un-displaced) modifier from Price List. |
Internal Medicine
| Fee Code | Description |
|---|---|
| 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 to 01.24BA.
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 to 01.24BB.
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 new subsections A and B 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:
Pediatrics
Obstetrician Gynecologist
Radiology
Anesthesia
Cardiology
Critical Care
Emergency
Neurology
Ophthalmology
Otolaryngology
Gastroenterology
Plastic Surgery
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