Tips for billing COVID-19 and AHCIP Virtual Codes

Update: Since this post, the Alberta government has made COVID-19 and virtual billing codes permanent. You can view our updated post here. 

The COVID-19 pandemic has changed how physicians provide care in Alberta, and as a result, it has changed physician medical billing. Alberta Health established five new categories of virtual care codes that allow physicians to bill for health care services provided over telephone or video conference. In this post, we review the do’s and dont’s of billing AHCIP virtual care codes.

About AHCIP Virtual Billing Codes:

The new AHCIP virtual medical billing codes allow physicians to continue providing a variety of healthcare during the COVID-19 pandemic, while allowing both physicians and patients to limit their exposure to the virus. Previously, many services billable with virtual codes could only be billed to Alberta Health if the care was provided by during an in person visit.

At the bottom of the article we have listed virtual care codes categories applicable during the COVID pandemic. For a detailed description of the all the COVID and virtual care codes, see our post on Virtual Medical Billing Codes and COVID-19.

When AHCIP Virutal Billing Codes are Valid:

All of the changes discussed below were announced in health bulletins throughout March, April and May 2020. They will be applied retroactively to March 17, 2020. Its is important to note that these new billing codes may only be claimed during the declared public health emergency pursuant to 52.1(1), of the Public Health Act. Once the public health emergency is over, these codes could continue if the Chief Medical Officer of Health determines, in their discretion, that they are appropriate even though a public health emergency has not been declared.

Tips and Reminders for Billing Virtual Care Codes:

There are some rules and restrictions that physicians should keep in mind when submitted virtual care medical billing codes. Below we address popular questions regarding these billing codes:

What Visits and Consultations that can be billed?

Visits must be initiated by the patient (or their agent). This can be a referral or the patient requesting physician services. The physician cannot initiate the service. Consultations are considered initiated on the patient’s behalf by virtue of the consultation request. For all of these codes, the medical bulletins are explicit that the Physician must provide the service.

What Records to should I keep?

When billing COVID virtual care codes, it is important to keep appropriate the records. Here are the records that should be kept and how they should be submitted:

Location of service – The location of the service is the location of the physician at time of service.

Patient Records – Patient record must reflect a detailed summary of the service.

Time Records – Record start and stop time of the virtual visit in the patient record

Are there any restrictions on billing virtual care codes?

Yes. There are several restrictions when billing virtual codes:

Patient time only – Alberta Health has stated that only physician to patient time can be claimed, meaning if you choose to complete charting/referral letters after the patient visit/consultation appointment has concluded, you cannot claim this time.

Daily per patient Code Limit – One virtual visit per patient, per physician, per day may be claimed

Restrictions with other codes – Virtual codes cannot be billed with other virtual services or in-person services provided on the same day, by the same physician, for the same patient

Restrictions on premiums – Additional premiums, such as age modifiers, complex modifiers, after hours time premiums, prolonged codes, BCP and RRNP will not apply to virtual codes

Visits less than 10 minutes – Virtual services that are 10 minutes or less MUST be claimed using 03.01AD regardless if the service was regarding COVID-19

Restriction on TELES modifer – The telehealth modifier TELES, does NOT apply to the virtual codes.

Limits for general virus information – None of the above virtual codes may be claimed for providing general information on the virus

Do Virtual Care codes count towards the Daily Visit Caps?

No. These codes will NOT count towards the daily patient cap introduced on March 31, 2020. The AHCIP virtual care codes listed above do not count towards the daily patient limit cap. In addition, retroactive to March 31, 2020, Group therapy and teaching fee codes (03.05LB, 08.44A, 08.44B, 08.44C,08.44D) have been added to the list of services exempt from the daily patient visit cap

What about COVID Diagnostic Codes?

If the patient consults the physician about COVID-19 or discusses the virus at the same time as other medical services, you should add the DI code 079.8(2) to the claim for tracking purposes. Note these apply only to COVID-19 related care. Other services billed under the virtual care codes unrelated to COVID-19 should not include these diagnostic codes.

What Patient Consent do I need when providing virtual care in Alberta

If videoconference is used, consent is required from the patient. If by telephone, consent is not required.

AHCIP Virtual Care Billing Codes

Here is a list of the updated virtual care codes categories applicable during the COVID pandemic. For a detailed description of the all the COVID and virtual care codes, see our post on Virtual Medical Billing Codes and COVID-19.

Visit Services: Includes HSCs: 03.03CV and 03.08FV

Consultation Services: Includes HSCs: 03.08CV and 08.19CX

Mental Health Services: Includes HSCs: 08.19CV and 08.19CW and 08.19CX

Chronic Pain Management / Palliative Care HSCs: 08.19CW

Nephrology and Critical Care Medicine HSCs 03.03FV

Telephone Advice to patient HSC: 03.01AD

COVID Billing Process for non-Residents of Canada: Diagnostic code 079.82 or 079.8

The COVID-19 pandemic has changed how physicians provide healthcare in Alberta. While these codes are temporary, it will be interesting to see if our experiences in the current “new normal” environment result in permanent changes to allow more virtual healthcare under the AHCIP schedule of medical benefits. As always, if you have questions, comments, or something to add, please let us know. We’re always happy to hear for you.

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