Alberta Fee Code Changes – Pediatrics, Obstetrics and Gynecology, Radiology



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 pediatrics, obstetrics and gynecology, or radiology.

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 ***

Pediatrics

Fee Code Description
03.03DG Complex pediatric hospital visits per full 15 minutes. NOTES: May only be claimed for visits where the patient is complex and requires a minimum of ***15 minutes on patient care management. (changed from 20).
03.05G ***Initial assessment of newborn.
03.05GA Care of healthy newborn in hospital (subsequent days) NOTE: May only be claimed when no other visit service has been provided on that day, regardless of physician. ***Addition of PED skill code.
03.08M Extended uro-gynecology, ***pediatric gynecological, gyne-oncology, reproductive endocrinology or perinatology consultation, per 15 minutes or major portion thereof.

The L13 modifier

The L13 modifier is an implicit modifier meaning the modifier does not need to be added to the claim to adjust payment.

L13 is automatically applied when the patient has not reached their 13th birthday.

50.94D Introduction of central venous catheter, with or without ultrasound guidance. NOTE: May not be claimed in addition to HSC 49.95A. ***Addition of L13 modifier
50.94E Introduction of catheter into peripheral vein, requiring ultrasound guidance NOTE: May not be claimed for routine venous access or initiation of intravenous. ***Addition of L13 modifier
50.94F Introduction of venous catheter for hyperalimentation, percutaneous or by cutdown. ***Deleted*** - refer to HSC 50.94D and 50.94E



Obstetrics and Gynecology

Fee Code Description
03.08M Extended uro-gynecology, ***pediatric gynecological, gyne-oncology, reproductive endocrinology or perinatology consultation, per 15 minutes or major portion thereof.
13.99JA Management of complex labour, per 15 minutes

Guidelines for 13.99JA


1. Time may be determined on a cumulative basis.

2. May be claimed for complex or non-progressive labour where the physician is actively managing a higher risk labour (defined as prolonged labour exceeding 12 hours during the first stage of labour or 1 hour during the second stage of labour, non-progressive labour, non-reassuring fetal/maternal status, multiple gestation, pregnancy induced hypertension, HELLP, insulin dependent diabetes, antepartum hemorrhage, pre-labour ruptured membranes, non-reassuring fetal heart tracing, multiple pregnancy and preterm labour, seizure disorder, unstable patient).

3. May only be claimed when the physician is on-site and immediately available or when called to monitor or reassess the patient with complex or non-progressing labour.

4. Only HSC 13.99JA or the services relating to labour provided may be claimed, but not both. Concurrent billing for overlapping time for separate patient encounters/services may not be claimed.

5. May be claimed in addition to HSCs 86.9 B, 86.9 D or 87.98A.

6. May not be claimed in addition to HSCs 87.98B or 87.98C.

7. A maximum of twelve 15-minute units may be claimed per patient per pregnancy. (changed from eight).  


Radiology

Fee Code Description
X128 ***Add Note 4 to read as follows: Bone mineral content determination dual photon absorptiometry with or without vertebral fracture assessment (VFA)


***NOTE 4***: Nurse Practitioners and physicians that are part of Cancer Control Alberta may refer for patients under 50 years of age who are at high risk of bone density loss. Text is required on both the referral and the claim to indicate the patient’s risk. 

X321 Ultrasound, obstetrical, second or third trimester, ***high-risk for example, significant maternal disease (i.e. diabetes), fetal anomaly, fetal markers, Intrauterine Growth Retardation (IUGR), oligohydramnios, growth discordance in twins, suspected fetal anemia, genetics, fetal therapy