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 pediatrics, obstetrics and gynecology, or radiology.
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 ***
Pediatrics
| Fee Code | Description |
|---|---|
| 03.03DG | Complex pediatric hospital visits per full 15 minutes. NOTES: May only be claimed for visits where the patient is complex and requires a minimum of ***15 minutes on patient care management. (changed from 20). |
| 03.05G | ***Initial assessment of newborn. |
| 03.05GA | Care of healthy newborn in hospital (subsequent days) NOTE: May only be claimed when no other visit service has been provided on that day, regardless of physician. ***Addition of PED skill code. |
| 03.08M | Extended uro-gynecology, ***pediatric gynecological, gyne-oncology, reproductive endocrinology or perinatology consultation, per 15 minutes or major portion thereof. |
The L13 modifier
The L13 modifier is an implicit modifier meaning the modifier does not need to be added to the claim to adjust payment.
L13 is automatically applied when the patient has not reached their 13th birthday.
| 50.94D | Introduction of central venous catheter, with or without ultrasound guidance. NOTE: May not be claimed in addition to HSC 49.95A. ***Addition of L13 modifier |
| 50.94E | Introduction of catheter into peripheral vein, requiring ultrasound guidance NOTE: May not be claimed for routine venous access or initiation of intravenous. ***Addition of L13 modifier |
| 50.94F | Introduction of venous catheter for hyperalimentation, percutaneous or by cutdown. ***Deleted*** – refer to HSC 50.94D and 50.94E |
Obstetrics and Gynecology
| Fee Code | Description |
|---|---|
| 03.08M | Extended uro-gynecology, ***pediatric gynecological, gyne-oncology, reproductive endocrinology or perinatology consultation, per 15 minutes or major portion thereof. |
| 13.99JA | Management of complex labour, per 15 minutes |
Guidelines for 13.99JA
1. Time may be determined on a cumulative basis.
2. May be claimed for complex or non-progressive labour where the physician is actively managing a higher risk labour (defined as prolonged labour exceeding 12 hours during the first stage of labour or 1 hour during the second stage of labour, non-progressive labour, non-reassuring fetal/maternal status, multiple gestation, pregnancy induced hypertension, HELLP, insulin dependent diabetes, antepartum hemorrhage, pre-labour ruptured membranes, non-reassuring fetal heart tracing, multiple pregnancy and preterm labour, seizure disorder, unstable patient).
3. May only be claimed when the physician is on-site and immediately available or when called to monitor or reassess the patient with complex or non-progressing labour.
4. Only HSC 13.99JA or the services relating to labour provided may be claimed, but not both. Concurrent billing for overlapping time for separate patient encounters/services may not be claimed.
5. May be claimed in addition to HSCs 86.9 B, 86.9 D or 87.98A.
6. May not be claimed in addition to HSCs 87.98B or 87.98C.
7. A maximum of twelve 15-minute units may be claimed per patient per pregnancy. (changed from eight).
Radiology
| Fee Code | Description |
|---|---|
| X128 | ***Add Note 4 to read as follows: Bone mineral content determination dual photon absorptiometry with or without vertebral fracture assessment (VFA) |
***NOTE 4***: Nurse Practitioners and physicians that are part of Cancer Control Alberta may refer for patients under 50 years of age who are at high risk of bone density loss. Text is required on both the referral and the claim to indicate the patient’s risk.
| X321 | Ultrasound, obstetrical, second or third trimester, ***high-risk for example, significant maternal disease (i.e. diabetes), fetal anomaly, fetal markers, Intrauterine Growth Retardation (IUGR), oligohydramnios, growth discordance in twins, suspected fetal anemia, genetics, fetal therapy |
Please refer to the Schedule of Medical Benefits for complete details.
If you’re looking for another specialty, check out the links below:
Anesthesia
Cardiology
Critical Care
Emergency
General Practice
Internal Medicine
Neurology
Ophthalmology
Otolaryngology
Gastroenterology
Plastic Surgery
This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.
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