Alberta Billing Primer: AB Virtual Billing Codes

Below is a quick update/refresher to pass on regarding virtual care billing and billing codes, including mental health codes. I suggest bookmarking and referring to the AMA Fee Navigator [Alberta Fee Navigator].

03.03CV + CMGP01 [https://www.albertadoctors.org/fee-navigator/hsc/03.03CV] - $59.77

Health Service Code 03.03CV: Assessment of a patient's condition via telephone or secure videoconference.
CMGP modifier [https://apps.albertadoctors.org/fee-navigator/billing-tips/cmgp-modifier] 

• This is probably the most common billing code for virtual visits that are not mental health.
• You need 15 minutes of total patient care time on the day of service: "Benefit includes the ordering of appropriate diagnostic tests and procedures as well as discussion with the patient.".
• Per the SOMB, this code is for "a physician must complete a limited assessment of a patient's condition requiring a history related to the presenting problems, appropriate records, and advice to the patient. The total physician time spent providing patient care activities must last a minimum of 10 minutes. If the total physician time spent on the same day is less than 10 minutes, the service must be claimed using HSC 03.01AD." and "May only be claimed if the service was initiated by the patient or their agent"
   

03.03CV [https://www.albertadoctors.org/fee-navigator/hsc/03.03CV] - $25.09

Health Service Code 03.03CV: Assessment of a patient's condition via telephone or secure videoconference.

• Category: V Visit
• Base rate: $25.09
• Same as above, but if total patient care time on the day of service does not reach the 15 minute threshold but is above the 10 minute threshold for 03.01AD.
• Per the SOMB, this code is for "a physician must complete a limited assessment of a patient's condition requiring a history related to the presenting problems, appropriate records, and advice to the patient. The total physician time spent providing patient care activities must last a minimum of 10 minutes. If the total physician time spent on the same day is less than 10 minutes, the service must be claimed using HSC 03.01AD."
   

08.19CW [https://www.albertadoctors.org/fee-navigator/hsc/08.19CW] - $50.28

• You can bill a new Call for each full 15 mins. So if you talk to the patient for 30 minutes you can bill 08.19CW with 2 Calls ($100.56).
• Most of my MH visits are one hour so I bill 08.19CW with 4 Calls ($201.12). It's quite well paid, I think, and is exactly the same rate as in-person 08.19G codes.
• Your first ICD diagnosis must be between 290 and 320 for this to be paid. Recall that 300 is Anxiety, 311 is Depression, 309 is Adjustment Reaction, 308 is Acute Reaction to Stress.
• "Only time spent communicating with the patient and/or the parent/guardian of a patient child can be claimed as part of the service. Time spent on administrative tasks cannot be claimed."
• Record the start and stop time of the service in the patient record.
• Per the SOMB, this code is for "Scheduled psychiatric treatment (including group therapy) by a general practitioner or pediatrician, or for a palliative care or a chronic pain visit by an eligible physician, per full 15 minutes."
   

03.01AD [https://www.albertadoctors.org/fee-navigator/hsc/03.01AD] - $20.00

• "May only be claimed if the service was initiated by the patient or their agent"
• "Advice to a patient or their agent via telephone, secure email or videoconference"
   

03.05JR [https://www.albertadoctors.org/fee-navigator/hsc/03.05JR] - $20.00

• As far as I'm aware, this can be an MD initiated phone call. But you can only bill 14 of these per week per MD.
• "A maximum of 14 telephone calls per physician, per calendar week may be claimed"
   

Billing references for consultations:

A) e-consults for typed consults/questions over "secure" platforms like Bright Squid. Exciting note - RD is building this secure messaging feature at Rocket Doctor, and anticipate releasing it in the fall on the platform!

• 03.01R Qs from GPs, etc (https://www.albertadoctors.org/fee-navigator/hsc/03.01R)
• 03.01O Responses from specialists (https://www.albertadoctors.org/fee-navigator/hsc/03.01O)

B) Phone consults

• 03.01 LG or LH or LI billed by the referring doc (https://www.albertadoctors.org/fee-navigator/hsc/03.01LG)
• 03.01 LJ ok LK or LL billed by the consulting doc (https://www.albertadoctors.org/fee-navigator/hsc/03.01LJ)

C) Typical faxed consults

• No fee charged by the referring doc.
• Only the consultant doc bills. For example: I see referrals to the Vesia Bladder Centre and I bill 03.08CV (03.08CV + CMXC30 if over 30 mins). (https://www.albertadoctors.org/fee-navigator/hsc/03.08CV)