Medical Claims Adjustment for E405A

Ashley Lane
Apr. 10, 2021
1-minute read

As of December 1st, 2020, the Alberta Ministry of Health implemented temporary complexity premiums for specific anesthesiology services in connection to COVID-19.  The premium added 30% to the anaesthesia extra units listed on page 111 of the Schedule of Benefits.

Unfortunately, there was a problem when applying the extra add-on and E405 didn’t get applied to all claims. If you submitted E405 between April 3, 2020 and July 31st, 2020 your claims will be reevaluated and if you originally missed out on the premium then your payment will be adjusted to make sure you receive the 30% extra.

No action is required on your behalf in order to receive this adjustment. You will find the adjustment on your March 2021 Remittance Advice with explanatory code ’55. This deduction is an adjustment on an earlier account’ and ’57-This payment is an adjustment on an earlier account’. The codes eligible anesthesiology extra unit fee codes are:

Fee Code Description
E010C Patient with body mass index (BMI) > 40
E011C Patient in prone position during surgery
E012C Patient who is known to have malignant hyperthermia or there is a strong suspicion of susceptibility, and the anaesthetic requires full malignant hyperthermia set up and management
E016C American Society of Anaesthesiologists (ASA) V-moribund patient not expected to live 24 hours with or without operation
E017C ASA IV-patient with incapacitating systemic disease that is a constant threat to life
E020C ASA E-patient undergoing anesthesia for emergency surgery which starts within 24 hours of operating room booking, to E022C, E017C or E016C
E021C Premature newborn less than 37 weeks gestational age
E022C ASA III-patient with severe systemic disease limiting activity but not incapacitating
E024C Patient in sitting position during surgery, greater than 60 degrees upright
E025C Unanticipated massive transfusion-transfusion of at least one blood volume of red blood cells

If you have any questions about this adjustment, don’t hesitate to reach out to our team.

This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.

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Ashley is a freelance writer who is passionate about healthcare, positive psychology, traveling, and cooking.
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