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  • Do you know how to claim for pre-operative history? | Alberta Medical Association
    Matters albertapatients Forms Website 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 Billing tips Do you know how to claim for pre operative history Do you know how to claim for pre operative history 03 04M If you are completing a pre operative history and physical examination and you are not the physician performing the procedure you may claim 03 04M CMXC30 modifier if applicable Please note that it is not appropriate to claim a consultation 03 08A for pre operative history and physical examination 03 04M is considered a visit service and therefore cannot be claimed by the operating physician within the inclusive care period category procedures 1 15 In the case where the operating surgeon does the pre operative history and physical examination it could be considered part of a consultation 03 07A 03 07B 03 07C 03 08A as appropriate and in accordance with the Governing Rules If a physical and or examination was not completed nothing can be claimed 03 04M is not billable to the Alberta Health Care Insurance Plan when it is in relation to an uninsured service A pre operative history and physical for dental procedures are only payable if the dental anesthetic is an insured service GR 10 Website feedback Member services Physicians Our Agreements Compensation and billing Billing help Schedule of Medical Benefits Online Billing Advice Billing tips How to bill for major portion thereof Lacerations 98 22A and 98 22B Goals of Care forms Dental pre op and related services After hours work over 2016 stat holidays WCB

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/billing-tips/preoperative-history (2016-02-01)
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  • Billing tip: Family conferences 03.05JB | Alberta Medical Association
    and billing Billing help Billing tips Billing tip Family conferences 03 05JB Billing tip Family conferences 03 05JB Family conferences that are formal scheduled conferences discussing the patient without the patient present may be claimed using 03 05JB Claims should be submitted using the PHN of the patient that is being discussed When a patient has a chaperone such as a family member s or spouse with him her at the visit this may not be claimed using 03 05JB Visits that include a chaperone should be claimed using the most appropriate visit code 03 02A 03 03A 03 04A Complex modifiers can be added to the claim as appropriate for any additional time spent managing the patient s care and communicating with the chaperone if required 03 05JB Formal scheduled family conference relating to a specific patient per 15 minutes or major portion thereof 03 05JB may be claimed at the same encounter as a patient visit if The visit service for the patient has ended and the chaperone requests additional time with the physician to discuss the patient When claiming one call the greater portion of 15 minutes must be spent discussing the patients care with the chaperone As per GR 2 3 5 additional calls may not be claimed until the full amount of time described in the HSC for each previous call has elapsed Clear documentation that the visit service has ended and the family conference was related to but not part of the original visit service must be recorded in the patient s record Claims for other services for concurrent time may not be submitted For example complex modifiers on the visit service CMXV CMGP CMXC may not be submitted for the same time period that a claim for 03 05JB is submitted Website feedback

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/billing-tips/family-conference-billing (2016-02-01)
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  • Post-operative complications | Alberta Medical Association
    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 Billing tips Post operative complications Post operative complications Post operative complications are billable to Alberta Health and Wellness Every health service code HSC in the Schedule of Medical Benefits SOMB is assigned a category code Procedures with a category code of 1 15 are assigned a pre operative and post operative period also called the inclusive care period Visits related to the procedure within the inclusive care period are considered to be part of the surgical benefit therefore they are not billable to Alberta Health Care Insurance Plan AHCIP Visits for 1 conservative measures in hospital only prior to surgery in an effort to avoid surgery and 2 post operative complications are the exceptions to this rule For example if a patient is admitted to the hospital under conservative orders intended to avoid surgery and then ultimately has to have surgery the pre operative visits can be billed to the AHCIP These claims will require text giving brief details of the situation and the need for pre operative visits Post operative complications in or out of hospital can also be billed to AHCIP with text to explain the situation and the need for post operative visits within the inclusive care period Routine post operative visits e g wound management are not billable to AHCIP Remember that WCB services are unbundled and all visits related to the procedure are billable to WCB Website feedback Member services Physicians Our Agreements Compensation and billing Billing help Schedule of Medical Benefits Online Billing Advice Billing tips How to bill for major portion thereof Lacerations 98 22A and 98 22B

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/billing-tips/post-operative-complications (2016-02-01)
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  • Resident-provided services | Alberta Medical Association
    Services Insurance Wealth management Do the paperwork Resident Physicians Medical Students Membership Guide Manage your membership Patients First Advocacy timeline Health issues Prescription Alberta Many Hands Physician Advocacy Immunization Other Patient Health Matters albertapatients Forms Website 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 Billing tips Resident provided services Resident provided services Physicians may not claim for resident provided services unless they directly supervise the service This is stated in Governing Rule 2 7 5 below as well as MED Bulletin 97 MED Bulletin 97 2 7 5 Claims may be submitted by a physician who is present and supervising a resident or intern during the provision of a service Telephone advice codes may not be claimed for speaking to the resident or intern Phone calls may only be claimed when both parties are licensed practicing physicians and in some cases licensed health care providers For more advice from AMA staff on any billing issues including explanations of recent billing changes please email AMA billing staff or visit Billing help on the AMA website Website feedback Member services Physicians Our Agreements Compensation and billing Billing help Schedule of Medical Benefits Online Billing Advice Billing tips How to bill for major portion thereof Lacerations 98 22A and 98 22B Goals of Care forms Dental pre op and related services After hours work over 2016 stat holidays WCB report fee adjustments coming April 1 and July 1 2016 Billing seminars Compensation programs Uninsured services Allocation Alternative Relationship Plans ARPs Economic indicators WCB Physician and Family Support Program PFSP Practice Management

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/billing-tips/resident-provided-services (2016-02-01)
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  • Visit with minor procedures | Alberta Medical Association
    Relationship Plans ARPs Economic indicators WCB Physician and Family Support Program PFSP Practice Management Program PMP AMA Physician Locum Services Insurance Wealth management Do the paperwork Resident Physicians Medical Students Membership Guide Manage your membership Patients First Advocacy timeline Health issues Prescription Alberta Many Hands Physician Advocacy Immunization Other Patient Health Matters albertapatients Forms Website 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 Billing tips Visit with minor procedures Visit with minor procedures The following codes may be claimed in addition to any visit service or consultation with the same diagnostic code for both the visit and procedure 13 59A Intramuscular or subcutaneous injections 16 81A Spinal tap 51 92A Varicose vein single injection 98 03A Incision and drainage of abscess or hematoma subcutaneous or submucous 98 12C Removal of sebaceous cyst 98 12J Removal or excision first lesion insured warts see the Schedule of Medical Benefits SOMB for full details Review the SOMB Website feedback Member services Physicians Our Agreements Compensation and billing Billing help Schedule of Medical Benefits Online Billing Advice Billing tips How to bill for major portion thereof Lacerations 98 22A and 98 22B Goals of Care forms Dental pre op and related services After hours work over 2016 stat holidays WCB report fee adjustments coming April 1 and July 1 2016 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 Services Insurance Wealth management Do the paperwork Resident Physicians Medical Students Membership Guide Manage your

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/billing-tips/visit-with-minor-procedures (2016-02-01)
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  • Visits in the pre- and post-operative period | Alberta Medical Association
    Hands Physician Advocacy Immunization Other Patient Health Matters albertapatients Forms Website 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 Billing tips Visits in the pre and post operative period Visits in the pre and post operative period Every health service code HSC in the Schedule of Medical Benefits SOMB is assigned a category code Procedures with a category code of 1 15 are assigned a pre operative and post operative period also called the inclusive care period Visits excluding consultations related to the procedure either before or after the procedure are considered to be related to the procedure and are therefore not billable Post operative complications and conservative measures hospital inpatients only before surgery as part of an effort to avoid surgery are the exception to this rule For example a patient who is admitted to hospital under conservative care intended to avoid surgery might ultimately need to have surgery You can bill pre operative visits to that patient to the Alberta Health Care Insurance Plan giving brief details of the situation Post operative complications can also be billed to AHCIP with an explanation of the situation and the need for post operative visits within the inclusive care period Website feedback Member services Physicians Our Agreements Compensation and billing Billing help Schedule of Medical Benefits Online Billing Advice Billing tips How to bill for major portion thereof Lacerations 98 22A and 98 22B Goals of Care forms Dental pre op and related services After hours work over 2016 stat holidays WCB report fee adjustments coming April 1 and

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/billing-tips/visits-in-the-pre-and-post-operative-period (2016-02-01)
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  • Are you missing out on billing when providing WCB services? | Alberta Medical Association
    Students Membership Guide Manage your membership Patients First Advocacy timeline Health issues Prescription Alberta Many Hands Physician Advocacy Immunization Other Patient Health Matters albertapatients Forms Website 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 Billing tips Are you missing out on billing when providing WCB services Are you missing out on billing when providing WCB services In general when submitting claims to WCB for work related illness injury physicians follow the same rules that apply to Alberta Health billing However WCB related services may be unbundled which means that Visits are payable in addition to the procedure regardless of diagnostic code or service location All services provided at the same encounter are payable at 100 No inclusive care periods for procedures all pre and post procedure visits are payable including suture removal which is claimed as a visit Tray services are billed separately Business Cost Program BCP services are billed separately 1 unit for every visit service 03 03A CMGP03 4 calls of BCP01 02 CP01 Locations other than Calgary or Airdrie BCP01 Locations other than Calgary or Airdrie BCP02 Calgary and Airdrie Website feedback Member services Physicians Our Agreements Compensation and billing Billing help Schedule of Medical Benefits Online Billing Advice Billing tips How to bill for major portion thereof Lacerations 98 22A and 98 22B Goals of Care forms Dental pre op and related services After hours work over 2016 stat holidays WCB report fee adjustments coming April 1 and July 1 2016 Billing seminars Compensation programs Uninsured services Allocation Alternative Relationship Plans ARPs Economic indicators

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/billing-tips/billing-for-WCB-services (2016-02-01)
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  • Billing WCB-Alberta for debridement | Alberta Medical Association
    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 Billing tips Billing WCB Alberta for debridement Billing WCB Alberta for debridement In 2010 Alberta Health changed its pricing for debridement procedures so that a functional area receives a higher rate than a non functional area A recent WCB Alberta audit of debridement billings revealed that some physicians are using the code for a non functional area when it is a functional area that was treated This creates an under payment for these physicians Alberta Health s Schedule of Medical Benefits SOMB Procedure List now states that a debridement of a wound or infected tissue can be claimed once per functional or non functional anatomical area as defined in rules 7 1 1 and 7 1 2 with the exception of paired structures which may be claimed as two anatomical areas Here are the definitions of the two rules 7 1 1 Functional Area Functional area includes the following anatomical areas head face neck shoulder axilla elbow wrist hand groin perineum knee ankle and foot and includes coverage of exposed vital structures bone tendon major vessel nerve 7 1 2 Non functional Area Non functional area includes the following anatomical areas posterior trunk anterior trunk arm above elbow forearm below elbow thigh and leg below knee For more advice from AMA staff on any billing issues please email AMA billing staff or visit Billing help on the AMA website login required Website feedback Member services Physicians Our Agreements Compensation and billing Billing help Schedule of Medical Benefits Online Billing Advice Billing tips How to bill for major portion thereof Lacerations 98 22A and 98 22B

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/billing-tips/WCB-debridement-billing-tip (2016-02-01)
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