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  • After-hours Time Premium 03.01AA | Alberta Medical Association
    bulk of the time was spent e g if the encounter starts at 21 55 and ends at 22 10 claim 03 01AA TNTP01 If the time spent managing patient care crosses over two time periods more than one modifier can be used e g if the encounter starts at 21 00 and ends at 23 45 claim 03 01AA TEV04 TNTP07 If the time spent managing patient care crosses two dates of service separate the claim into two claims with two dates of service For example if the encounter starts on day one at 21 00 and ends on day two at 00 45 the claim would look like this Claim one for day one 03 01AA TEV04 TNTP08 Claim two for day two 03 01AA TNTA03 This fee code may not be claimed for the following Stand by time Completing discharge summaries or clinical notations after the patient has been discharged unless the patient was seen on the same day More than four units per hour per physician may not be claimed the time claimed cannot exceed actual time spent managing patient care Providing uninsured services Non physician time Additional information This HSC is claimed on a time basis and pays strictly for the time spent managing the patient s care in relation to an insured service 03 01AA is claimed in 15 minute units Only the time that the physician actually spent managing patient care is billable 03 01AA is billable in addition to other services at the same encounter on the same date of service for after hours work Modifiers that apply to 03 01AA are as follows TEV weekdays 17 00 22 00 Maximum of 20 units TNTP 22 00 24 00 Maximum of 8 units TNTA 24 00 07 00 Maximum of 28 units TWK weekends 07 00 22 00 Maximum of 60 units TST 07 00 22 00 statutory holidays Maximum of 60 units TDES designated statutory holidays 07 00 22 00 Maximum of 60 units A claim for 03 01AA must include a modifier that signals the time of day and the length of time it took to provide the service For example if the service started at 20 15 hours and took 45 minutes the claim for 03 01AA would look like this HSC 03 01AA modifier TEV03 The TEV portion of the modifier signals that the service was provided in the evening The 03 portion of the modifier signals that the service took approximately 45 minutes Please note Claims for overlapping time may not be submitted Only 4 units are billable per hour per physician Some examples Billing scenario 1 On a Monday night at 22 30 an internist gets a call from the nurse on the ward requesting that s he come on a priority basis to the hospital to assess a patient s condition The total time spent managing the patient s care is 38 minutes The claim would look like this 03 03QA in patient callback 22

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/online-billing-advice/after-hours-time-premium (2016-02-01)
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  • BMI, Body Mass Indicator | Alberta Medical Association
    BMI Body Mass Indicator BMI Body Mass Indicator Criteria The BMIPRO modifier is billable for eligible services provided in any location including the physician s office when the patient has met the criteria for BMI An adult patient has a body mass index of 35 or more A patient under 18 years of age who is above the 97th percentile for BMI on an approved pediatric growth curve The BMI modifier increases the payment of a procedure s by 25 when applied to specific procedures consult the Medical Price Benefits List or the AMA Fee Navigator www albertadoctors org feenav to see which HSCs have the BMI modifier listed The modifier can be applied to all services provided by the surgeon surgical assistant or anesthesiologist at the same encounter Access the Medical Price Benefits List Additional information Make sure to apply the BMI modifier correctly on all of the applicable claims that are submitted for the patient Some physicians are only entering BMI into the modifier field This is not a valid modifier and will not result in payment of the additional 25 The correct modifier to enter into the modifier field for the role of the surgeon is BMIPRO Surgical assist requires two modifiers SA into one field and BMIPRO into another field The appropriate BMI modifiers for anesthesia are as follows choose one as appropriate BMIANE Anesthetic services claimed by procedure BMIANT Anesthetic services claimed by time ANEST BMI2AN Anesthetic services claimed by 2ANES BMIABD The physician functions as the anesthetist and is claiming a Health Service Code HSC which is an anesthetic by definition and does not have the modifier ANE epidural or dental anesthetic Governing rules 18 Need more help Access the Schedule of Medical Benefits Read the Physician Resource Guide Register for billing seminars Contact

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/online-billing-advice/bmi (2016-02-01)
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  • Callback to Closed Office, 03.05S | Alberta Medical Association
    and login help Media Publications Member Sign in AMA member number Password Forgot your password Login help Alberta Medical Association Member Sign in AMA member number Password Forgot your password Login help About the AMA Leaders Partners Member services Patients First Home Member services Physicians Compensation and billing Billing help Online Billing Advice Callback to Closed Office 03 05S Callback to Closed Office 03 05S Criteria All of the following criteria must be met The physician must have been called to a closed office without any staff present A patient can make the request for the physician to return to the office The physician must travel to the office where no staff are present The physician may only claim 03 05S for the first patient seen Claims for second and subsequent patients seen after the initial callback must be submitted using the appropriate visit or procedural code This fee code may not be claimed for the following Second and subsequent patients after the initial callback An office that is not closed or that has staff present Additional information These codes may be billed with a SUBD modifier indicating the time of day the event occurred OFEV 17 00 22 00 hours OFEVWK 07 00 22 00 hours Saturday Sunday or statutory holiday OFEVNTPM 22 00 24 00 hours any day OFNTAM 22 00 07 00 hours any day Need more help Access the Schedule of Medical Benefits Read the Physician Resource Guide Register for billing seminars Contact us with any billing questions Website feedback Member services Physicians Our Agreements Compensation and billing Billing help Schedule of Medical Benefits Online Billing Advice Billing tips Billing seminars Compensation programs Uninsured services Allocation Alternative Relationship Plans ARPs Economic indicators WCB Physician and Family Support Program PFSP Practice Management Program PMP AMA Physician Locum

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/online-billing-advice/callback-to-closed-office (2016-02-01)
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  • Callbacks to Long-Term Care | Alberta Medical Association
    The physician responds from outside the facility hospital LTC on an unscheduled priority basis There is direct physician attendance The claim must be based on the time the encounter begins and not the time of the call Maximums that include both callbacks to in and outpatients per physician per day apply 03 03KA or 03 05N Maximum five or any combination on any weekday 07 00 17 00 hours 03 03LA or 03 05P Maximum five or any combination on any weekday 17 00 22 00 hours 03 03LA or 03 05R Maximum 15 or any combination on any weekend day or statutory holiday 07 00 17 00 hours 03 03MC or 03 05QA Maximum two or any combination any day 22 00 24 00 hours 03 03MD or 03 05QB Maximum seven or any combination any day 24 00 07 00 hours This fee code may not be claimed for the following Second and subsequent patients seen at the same callback For second and subsequent patients seen at the same callback use 03 03AR if the criteria for 03 03AR are met Encounters where the physician has initiated the service i e scheduled it with the patient asked the patient to return later in the day returned to observe the patient or continued a previous service Callbacks cannot be claimed in addition to psychiatric services procedures anesthetics or consultations Surcharge modifiers may apply Additional information Callbacks should be claimed in addition to a visit For inpatients When 03 03D has been claimed at a previous encounter 03 03DF should also be claimed For LTC or auxiliary hospital callbacks use 03 03EA However if the patient has acute intercurrent illness and requires more frequent visits use 03 03DF if 03 03D for the patient has previously been claimed for the same illness The admission date on the claim for the 03 03D will be the date the intercurrent illness started Callbacks can be claimed in addition to a visit when the purpose of the callback is to pronounce a patient s death G R 4 15 There is nothing billable for completing a death certificate All criteria for a callback must still be met Otherwise only a visit item may be claimed for pronouncing the patient dead After hours time premium 03 01AA may be claimed for the total time spent managing patient care when services are provided after hours in a regional facility Access After hours Time Premium 03 01AA Access a chart that breaks down callbacks into their billable components Download the Callback to LTC on a Priority Basis chart Related fee codes After hours Time Premium 03 01AA 03 03AR Urgent or priority attendance on hospital inpatient or long term care inpatient at request of facility staff when physician is already on site May only be claimed by the patient s physician of record or by physicians working as part of an on call rotation May not be claimed by physician extenders May only be claimed for

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/online-billing-advice/callbacks-to-LTC (2016-02-01)
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  • CMGP Complexity Modifier | Alberta Medical Association
    03A 03 03B 03 03C 03 03N 03 03P 03 03Q 03 07A 03 07B The time used to calculate the modifier includes the following activities which must be completed on the same date of service that the patient was seen Writing a referral letter Charting Reviewing the chart Reviewing but not waiting for lab DI results Talking to and examining the patient Anything the physician does in relation to the patient s care Examples If the physician spends of total of 18 minutes managing the patient s care including charting the claim could look like this 03 03A modifier CMGP01 40 minutes including the visit and managing the patient s care the claim could look like this 03 03A modifier CMGP03 This fee code may not be claimed for the following The total time claimed Must only include the physician s time and not the time of other facility or office staff or residents Cannot include time spent delivering other billable services e g pap smears injections etc The time claimed cannot include time spent Delivering uninsured services Developing a Comprehensive Care Plan 03 04J Additional information The table below will help you to determine the number of units of the CMGP modifier you may claim for the total time spent This time includes the face to face visit part of the visit and the allowable activities mentioned above The CMGP modifier is payable up to 10 units or 105 minutes or more of time Table Claiming the CMGP modifier Time spent on patient care including visit Modifier 0 14 minutes N A 15 24 minutes CMGP01 25 34 minutes CMGP02 35 44 minutes CMGP03 45 54 minutes CMGP04 55 64 minutes CMGP05 65 74 minutes CMGP06 75 84 minutes CMGP07 85 94 minutes CMGP08 95 104 minutes CMGP09

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/online-billing-advice/cmgp-complexity-modifier (2016-02-01)
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  • CMXV15, CMXV30 | Alberta Medical Association
    This modifier describes time spent managing patient care Activities that contribute to managing the patients care include Writing a referral letter Charting Reviewing the chart Reviewing but not waiting for lab DI results Talking with and examining the patient Anything else the physician does in relation to the patient s care on the same date of service The total time claimed Must only include the physician s time and not other facility or office staff or resident physicians Cannot include time spent delivering other billable services e g injections etc This modifier is used to indicate a complex patient consultation or visit requiring that the physician spend 15 CMXV15 or 30 CMXV30 minutes or more on managing the patient s care This modifier can only be claimed by Community medicine geriatric medicine occupational medicine radiation oncology 03 03A 03 07A 03 07B Cardiology endocrinology metabolism hematology infectious diseases internal medicine medical oncology nephrology pediatric cardiology and pediatrics HSCs 03 03A 03 03F 03 07A 03 07B Pediatrics may also submit for 03 05JK This fee code may not be claimed for the following Uninsured services Non physician time Review of diagnostic information received on a day when patient not seen Time spent delivering another billable service Additional information CMXV15 may be claimed once the visit service and the management of the patient s care has reached 15 minutes Only one modifier may be added to the claim CMXV30 may be claimed once the visit service and the management of the patient s care has reached 30 minutes CMXV15 and CMXV30 may be claimed on relevant HSCs regardless of location 03 01AA after hours time premium may be claimed in addition to these modifiers if the service occurs in a regional facility after hours Need more help Access the Schedule of

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/online-billing-advice/cmxv15-cmxv30 (2016-02-01)
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  • CMXV20, CMXV35 | Alberta Medical Association
    same date of service the patient was seen Writing a referral letter Charting Reviewing the chart Reviewing but not waiting for lab DI results Talking with and examining the patient Anything else the physician does in relation to the patient s care The total time claimed Must only include the physician s time and not other facility or office staff or residents Cannot include time spent delivering other billable services e g Pap smears injections etc Additional information CMXV20 and CMXV35 may be claimed by the following specialties anesthesia obstetrics and gynaecology clinical immunology and allergy occupational medicine specialty community medicine specialists ophthalmology critical care medicine orthopedics cardiac surgeon otolaryngology cardiovascular and thoracic surgery pathology dermatology physical medicine and rehabilitation diagnostic radiology plastic surgery emergency medicine psychiatry full time emergency room rheumatology gastroenterology respiratory medicine generalists in mental health specialists in mental health general surgery thoracic surgery haematological pathology urology neurology vascular surgery neurosurgery The following HSCs are eligible for the following as appropriate to the physician s specialty CMXV20 or CMXV35 03 03A 03 03B 03 03C 03 03F 03 07A 03 07B 03 07C CMXV20 or CMXV35 may also be claimed by any physician for the following when the location and time conditions above are met HSCs 03 05CR 03 05FE 03 05DR 03 05FF 03 05ER 03 05FG 03 05F 03 05FH 03 05FA 03 05FR 03 05FB 03 05GR 03 05FC 03 05HR 03 05FD Other information CMXV20 may be claimed once the visit service and the management of the patient s care have reached 20 minutes CMXV35 may be claimed once the visit service and the management of the patient s care have reached 35 minutes Only one modifier may be added to the claim CMXV15 and CMXV30 may be claimed on relevant HSCs regardless

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/online-billing-advice/cmxv-20-cmxv35 (2016-02-01)
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  • COINPT | Alberta Medical Association
    Online Billing Advice COINPT COINPT replaces COMX Criteria All of the following criteria must be met COINPT This modifier is different in that both criteria listed below must be met in order to claim for services provided in acute care facilities The physician must spend a minimum of 20 minutes on managing the patient s care and The patient is a complex hospital inpatient with multi system disease whose co morbidities complicate or increase the care required by the physicians involved COINPT In order to submit claims for the COINPT modifier for patients in LTC facilities the patient must Be suffering from the conditions above or Have acute intercurrent illness and the physician has spent 20 minutes or more on patient care This modifier can only be claimed once per day per physician per patient for acute care patients on HSCs 03 03D 03 03AR Managing the patient s care includes the following activities which must be completed on the same date of service that the patient was seen Writing a referral letter Charting Reviewing the chart Reviewing but not waiting for lab DI results Talking to and examining the patient Anything the physician does in relation to the patient s care This fee code may not be claimed for the following When the physician has only met one of the qualifying criteria mentioned above Additional information The COMX modifier was deleted April 1 2014 The COINPT modifier replaces the COMX modifer and allows physicians to use a complexity modifier for LTC patients For dates of service April 1 2014 and going forward please use the COINPT modifier as appropriate Related fee codes 03 03D 03 03AR Need more help Access the Schedule of Medical Benefits Read the Physician Resource Guide Register for billing seminars Contact us with any billing

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/online-billing-advice/comx-complex-coinpt (2016-02-01)
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