Fee Navigator

    Health Service Code 03.01LJ

    Physician, nurse practitioner, midwife or podiatric surgeon to physician telephone or telehealth videoconference or secure videoconference consultation, consultant, weekdays 0700 to 1700 hours

    NOTE:

    Refer to notes following HSC 03.01LL.

    Additional notes:
    • Listed under 03.01LL - Physician, nurse practitioner, midwife or podiatric surgeon to physician telephone or telehealth videoconference or secure videoconference consultation, consultant, any day 2200 to 0700 hours:
      1. HSCs 03.01LJ, 03.01LK, 03.01LL may only be claimed when initiated by the referring physician, nurse practitioner, midwife or podiatric surgeon.
      2. The consultant may not claim a major consultation or procedure for the same patient for the same condition within 24 hours unless the patient was transferred from an outside facility and advice was given on management of that patient prior to transfer.
      3. May only be claimed when the consultant has provided an opinion and recommendations for patient treatment as well as management after reviewing pertinent family/patient history and history of the presenting complaint as well as discussion of the patient's condition and management after reviewing laboratory and other data where indicated. It is expected that the purpose of the call will be to seek the advice of a physician more experienced in treating the particular problem in question, and that the referring physician, nurse practitioner, midwife or podiatric surgeon intends to continue to care for the patient.
      4. May not be claimed for situations where the purpose of the call is to:
        • arrange for an expedited consultation or procedure within 24 hours except when the conditions in note 2 are met
        • arrange for laboratory or diagnostic investigations
        • discuss or inform the referring physician or podiatric surgeon of results of diagnostic investigations.
      5. A maximum of two (any combination of HSC 03.01LJ, 03.01LK, 03.01LL) claims may be claimed per patient, per physician, per day.
      6. Documentation must be recorded by both the referring physician, nurse practitioner, midwife or the podiatric surgeon and the consultant in their respective records.
      7. Telehealth videoconferences may only be claimed when all participants are participating in the videoconference from regional telehealth facilities.
      8. Claims for secure videoconference may only be claimed when the service is provided using a secure videoconference system that is in compliance with the CPSA guidelines on secure electronic communication and when the physician/clinic has submitted a Privacy Impact Assessment for this service accepted by the Office of the Privacy Commissioner of Alberta. communication and when the physician/clinic has submitted a Privacy Impact Assessment for this service accepted by the Office of the Privacy Commissioner of Alberta.
      9. Advice to nurse practitioners may only be claimed if the nurse practitioner is in autonomous practice or working at a nursing station where no physician is present.
      10. Advice to midwives may be claimed if the midwife is in independent practice or working at a midwifery center.
    Category:V Visit
    Base rate:$77.74

    AMA billing tips:

    • The consultant may only claim this service when treatment, recommendations or advice is given to the referring physician. If the purpose of the call is to collect or relay patient information such as in the case of transfer of care or information regarding results or further diagnostics, fee codes for phone advice may not be claimed.

      If a phone call and a consultation are claimed on the same day by the consultant physician in the same facility, AND the patient was transferred from an outside facility, text will be required on the claim for the phone call to state that the patient was transferred from an outside facility and the text must state the location that the patient was transferred from.

      Claims for speaking to NP's or Midwives may be submitted providing the NP or the midwife are in independent practice and the patient is not known to the consulting physician at the time of the call.

    • Videoconference technology means communication via SECURE videoconferencing systems but not necessarily part of a telehealth videoconferencing service. This service may not be claimed for team conferences that occur via telephone.

    • The PRACID of the referring physician must be entered into the claim in order to receive payment for these services.

    • The notes of the physician to physician phone call codes preclude claiming the service when the service is in regards to arranging lab or diagnostics or discussing results, the limitation on the phone calls also extends to discussions regarding which test or diagnostic to order.

    Fee modifiers:

    No modifiers.

    Governing Rules: