Family Medicine Billing Quick List Alberta Health & Wellness (AH & W) Billing Codes Updated May 19, 2011 Complete listing available at http://www.health.gov.ab.ca/professionals/SOMB/Price_List.pdf Code Description Fee MODIFIERS: The new CMGP complexity modifiers will replace the CMXV15 and CMXV30 modifiers. The CMGP modifier may be claimed if the physician spends 15 minutes or more managing patient care. The modifier includes: writing referral letters, charting, reviewing the chart, reviewing, but not waiting for lab/DI results. Applies only to 03A, 03B, 03C, 07A/07B. to maximum of CMGP01 > 15 minutes 15.70/unit CMGP02 > 25 minutes 15.70/unit CMGP06 > 65 minutes 15.70/unit VISIT - Complex & Routine 03.03A 03.04A 03.04J Office visit not requiring complete (Automatic increase by 20% if > 75) Comprehensive visit/physical q180d Development, documentation, and administration of comprehensive annual care plan for a patient with complex needs community office Note: For more details for 03.04J see complete listing $35.91 $88.90 $213.80 VISIT - Obstetrical 03.03B 03.03C 03.04B Prenatal visit Post-partum visit First prenatal/physical в‰Ґ q 90d, once/pregnancy $35.26 $35.26 $91.70 VISIT - Call Back 03.05S Call-back to office when closed (check time modifier) $53.25 VISIT - Senior 03.03A 03.05H 03.04K Office visit of patient 75yrs and older (20% added to 03.03A. Implicit, will automatically identified for patients over 75 years) Senior's driver's medical > 74.5 yrs Comprehensive geriatric assessment, first hour and 30 minutes (regional facility only) $35.91 $76.90 $300.00 Note: For more details for 03.04K see complete listing LONG TERM CARE/NURSING HOME 03.03AR 03.03E 03.03KA 03.03LA 03.03MC 03.03MD 03.03EA 03.04D 03.05JD 03.05JE Urgent or priority attendance requested by staff when MD already on site Nursing home periodic care once per calendar week Nursing home call-back 0700-1700 W/D Nursing home call-back 1 700-2200 W/D, 0700-2200 W/E, STATS Nursing home call-back 2200-2400 any day Nursing home call-back 2400-0700 any day Visit to nursing home in association with a special callback (HSC 03.03KA, 03.03LA, 03.03MC, 03.03MD) Admission to nursing home Formal, scheduled, multiple health discipline team conference (per 5 minute unit) Formal, scheduled review of medication by most responsible MD This document is produced and updated by the Department of Family Medicine, Alberta Health Services - Calgary $38.78 $27.17 $71.03 $93.58 $181.43 $181.43 $28.47 $105.50 $13.09 $27.29 Page 1 / 3 Code Description Fee VISIT - Consult 03.08A Comprehensive consult (incl PRACID of referring MD, midwife, dentist, NP, other) $104.55 ANTICOAGULATION 03.01N Mgmt of anticoagulant therapy (max. twice monthly regardless of physician providing service $16.95 Community Mental Health worker communication 0700-1700 W/D Community Mental Health worker communication 1700-2200 W/D or 0700-2200 W/E, STATS Community Mental Health worker communication 2200-0700 any day Note: above must be initiated by Community Mental Health Care Worker MD-MD phone advice - referring physician - 0700-1700 W/D MD-MD phone advice - referring physician - 1700-2200 W/D or 0700-2200 W/E, STATS MD-MD phone advice - referring physician - 2200-0700 any day Note: may be claimed in addition to visit; documentation required; max 2/pt/MD/day Advice to assisted living, lodge, hospital, LTC, NP or Home Care 0700-1700W/D $16.95 $23.92 $28.22 PHONE ADVICE 03.01B 03.01BA 03.01BB 03.01LG 03.01LH 03.01LI 03.01NG 03.01NH 03.01NI Advice to assisted living, lodge, hospital, LTC, NP or Home Care 1700-2200W/D, W/E, STATS Advice to assisted living, lodge, hospital, LTC, NP or Home Care 2200-0700 any day $35.50 $52.54 $62.01 $16.95 $25.03 $29.54 FAMILY PHYSICIAN AS THE CONSULTANT (more details see complete listing) 03.01LJ 03.01LK 03.01LL MD-MD telephone/ health consult, W/D 0700-1700 HRS MD-MD telphone /health consult, W/D 1700-2200 hrs, W/E & STATS0700-2200 MD-podiatric surgeon to physician telephone/health, any day 2200-0700 hrs $74.18 $109.80 $129.58 PROCEDURES IN OFFICE - SELECTED (check fee guide re M+ or M) 03.37A 03.38D 07.53вЂ¦ 07.57A 07.57B 12.01 12.21 12.31 13.42A 13.53B 13.59A 13.59J 13.99BA 25.1A 37.91A 61.03 80.83B 81.8 93.91A 93.91B 95.93 95.94A 95.96A 97.81 98.03A 98.04A 98.04B 98.11D 98.12A 98.12B 98.12C 98.12H Vital capacity (not peak flow meter) Vitalometry, alone Casts (consult detailed listing) Initial treatment minor burn Subsequent dressing/debriding Removal of FB from nose without incision Removal of FB from ear without incision Removal of non penetrating FB from eye Allergy injection (allows 03.03A 1/month) may be provided by nurse Intralesional steroid injection Im or sc injection & visit code Local aneasthetic trigger point injection (max 3) Pap smear (bill in addition to office visit) (max 2/pt/MD/yr) Removal foreign body cornea with incision Clip simple tongue tie Excsision perianal skin tag Endometrial biopsy (bill in addition to office visit) IUD insertion (bill in addition to office visit) Joint aspiration, injection, hip Joint aspiration/injection except hip (bill in addition to office visit) Injection shoulder bursa Injection trigger point with spray+ stretch Injection bursa/tendon/ganglion Needle biopsy breast I+D abscess Removal foreign body, skin, with anaesthesia Removal foreigh body, skin, subcu tissue without anaesthetic Extensive debriding up to 32cm^2 Excisional skin biopsy + visit * Excisional skin biospy face + visit * * Note: For more details for 98.12A & 98.12B see complete listing Excision sebaceous cyst + visit (maximum 3) Excision soft-tissue tumor + visit This document is produced and updated by the Department of Family Medicine, Alberta Health Services - Calgary $9.88 $14.77 various $36.23 $38.78 $67.96 $71.15 $31.66 $9.16 $21.66 $10.30 $27.77 $22.56 $36.41 $49.75 $44.99 $42.42 $66.67 $35.99 $21.86 $17.54 $63.73 $12.75 $43.25 $34.84 $59.96 $30.50 $130.14 $40.55 $54.27 $58.16 $78.18 Page 2 / 3 Code Description Fee 98.12J 98.12L 98.12S 98.22A 98.22B 98.81B 98.96A Removal, excision 1st lesion, wart/keratosis + visit Cryo/therapy warts (genital/plantar, molluscum, actin./irritated seb. keratosis) (bill in addition to office visit) Nonsurgical removal condylomata Suture laceration face <2.5cm, body <5cm Suture laceration face >2.5cm, body >5cm (+ $24.07 per additional 2.5/5cm segment) Skin punch biopsy Wedge resection toenail $24.18 $20.45 $26.22 $60.99 $50.24 $32.88 $51.64 Conference with relative re: psychiatric patient - list who conf. was with i.e mother (per 15 minute unit) Conference with allied health/education workers re: psychiatric patient (per 15 minute unit) Psychotherapy incl. Pharmacotherapy (per 15 minute unit) Family therapy 45 minutes $37.07 $36.08 $41.69 $141.54 COUNSELLING 08.19D 08.19F 08.19G 08.45 COUNSELLING - Palliative Care 03.05I 03.05T Counselling patient re: palliative care issues Counselling with family or allied health worker re: palliative patient $49.51 $46.13 COUNSELLING - Chronic Pain 03.05O 03.05X Chronic pain management (if patient has been to multidisc. pain clinic) Counselling family of chronic pain patient (as per 03.05O) $43.60 $46.86 Home visit, 1st patient, 0700-1700 weekdays (use time modifier) $88.16 HOME VISITS 03.03N TEAM CONFERENCE 03.05JA 03.05JB 03.05JC Formal, scheduled mulitple health discipline team conference (per 15 minute unit) Formal, scheduled family conference (per 15 minute unit) Family conference relating to acute, nursing home, emerg, or auxiliary patient (per 15 min) $42.60 $46.86 $42.60 HOSPITAL CARE 03.04C 03.03D 03.03AR 03.05M Hospital admisstion, M-F 0700-1700 (use time modifier) CMXC30 elegible Daily hospital visit per day (days 1-7) (day 8+ $21.66) COMX elegible Urgent or priority attendance requested by staff when MD already on site Supportive care in hospital (max 4/admission) $123.78 $51.25 $38.78 $17.74 FLU VACCINATION 13.59A Flu vacinations are only billable if the following conditions are met (administered by nurse or physician) Can add to visit * Persons 65 or older * Residents of a nursing home & other chronic care facilities * Adults with chronic conditions $10.30 * Health care workers in facilities where in constant contact with person in the high risk group Note: Any time a general symptom diagnostic code is used for the visit in conjunction with a minor procedure, in this case the flu shot, AH & W's treats the visit as related. A specific diagnostic code that is unrelated to the procedure must be used in order for both to be paid. * 03.01AA 15 minute time blocks for call bck to Long Term Care/Nursing Home * WCB - visit and follow up - add on after AHC This document is produced and updated by the Department of Family Medicine, Alberta Health Services - Calgary Page 3 / 3