Alberta Fee Code Changes – Neurology, Ophthalmology and Otolaryngology

AHCIP has updated and released a new “Schedule of Medical Benefits,” effective as of November 1, 2018. The following guide is a quick reference to new changes that affect physicians who specialize in neurology, ophthalmology or otolaryngology.

Please note that the new Alberta fee codes are automatically available on Dr. Bill, they will appear on any claim with a ‘Date of Service’, on or after November 1st. If the ‘Date of Service’ is set before November 1st, it will show the old code along with its expiry date.

Any claims that are have already been submitted to AHCIP with the old fees but after November 1st, will come back as adjustments and our billing team will automatically handle them for you.

Click here for changes affecting all Alberta physicians.


Note: all new changes are marked with ***

Neurology

Fee Code Description
03.03FA ***Addition of MDON and NEUR to list of skill codes that are eligible to claim for the service. Prolonged repeat office or scheduled outpatient visit in a regional facility, referred cases only, full 15 minutes or portion thereof for the first call when only one call is claimed.

Guidelines for 03.03FA

1. May only be claimed in addition to HSC 03.03F when the 03.03F exceeds 30 minutes.

2. May only be claimed by pediatrics (including subspecialties) and clinical immunology and allergy for patients 18 years of age and under, or by cardiology, endocrinology/metabolism, gastroenterology, infectious diseases, internal medicine, hematology, medical genetics, ***medical oncology, neurology, physiatry, respiratory medicine, rheumatology, urology and vascular surgery (no age restriction).

Ophthalmology

Fee Code Description
***GR 6.5 ***NON-INVASIVE DIAGNOSTIC PROCEDURES IN HOSPITAL, AACC OR UCC Add HSCs 03.39A, 03.39B, 03.44A, 09.02E, 09.13G, 09.13H.
03.08H Formal major neuro-ophthalmology consultation, ***including complex consultations of orbit or oncology.
13.57A Iontophoresis, ***ionization or gluing of corneal ulcer.
21.71 Dacryocystorhinostomy (DCR) ***Addition of BMIPRO modifier.
***L10 ***UNDER 10 YEARS - The patient has not reached their 10th birthday. tip: L10 is an implicit modifier meaning the payment rate will be adjusted automatically for patients that have not reached their 10th birthday. It is not necessary to add the L10 modifier to the claim to have the rate adjusted.

Note: ***Add L10 to the following codes:

22.13A            22.4A               26.2B               26.71               28.72B
22.13B             22.55A             26.25B             27.72A             29.02A

22.13C***Non cosmetic Excision of benign tumor of eyelid not requiring pathology analysis, ***for functional reasons including obstruction of visual axis, tearing, inflammation, or lid malposition ***NOTE: For services requiring pathology analysis see HSC 22.13A. (Amending the wording to better define the criteria for insurability under the Alberta Health Care Insurance Plan. Those not meeting the criteria are considered uninsured.)
22.32AMajor full thickness repair of lid involving eyelid margin entropion, ectropion, trauma or tumor) ***Addition of BMIPRO modifier.
23.99AStrabismus repair, one muscle ***Adjust CALL NBRSER 2-6 to pay 75% from the current 56%.
27.72A Phacoemulsification cataract extraction, anterior approach, with or without insertion of intraocular lens. ***Addition of BMIPRO modifier.
28.72BPosterior total vitrectomy with 2 or 3 port infusion and cutting device. ***Addition of BMIPRO modifier.
29.02A ***Complicated orbital reconstruction or tumor excision - first 90 minutes.



Otolaryngology

Fee Codes Description
17.08G Division of nerves to sternomastoid in neck. ***Deleted.
20.55C Transphenoidal or transethmoidal hypophysectomy, Otolaryngological component. ***Deleted.
32.5 A Fenestration of lateral semi-circular canal. ***Deleted.
32.71A Decompression and shunt of endolymphatic sac. ***Deleted.
32.79A Excision of glomus tumors, Shambough operation. ***Deleted.
32.79E Labyrinth destruction, Cawthorne operation. ***Deleted.
43.0 A ***Laryngeal injection of material excluding Botulinum A Toxin.