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    Health Service Code 03.01O

    Physician or Nurse Practitioner to Physician secure E-Consultation, consultant

    NOTE:
    1. May only be claimed when both the referring physician or referring nurse practitioner and the consulting physician exchange communication using secure electronic communication that is in compliance with the CPSA guidelines on secure electronic communication and when the physician/nurse practitioner/clinic has submitted a Privacy Impact Assessment for this service acceptable to the Office of the Privacy Commissioner of Alberta.
    2. This service is only eligible for payment if the consultant physician has provided an opinion/advice and/or recommendations for patient treatment and/or management within thirty (30) days from the date of the e-consultation request.
    3. May only be claimed when initiated by the referring physician or referring nurse practitioner.
    4. The consultant may not claim a major consultation, physician to physician phone call, or procedure for the same patient for the same condition within 24 hours of receiving the request for an e-consultation unless the patient was transferred from an outside facility and advice was given on management of that patient prior to transfer.
    5. 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, history of the presenting complaint as well as laboratory and other data where indicated. It is expected that the purpose of the communication will be to seek the advice of a physician more experienced in treating the particular problem in question, and that the referring physician or referring nurse practitioner intends to continue to care for the patient.
    6. May not be claimed for situations where the purpose of the communication is to: a. arrange for an expedited consultation or procedure within 24 hours except when the conditions in note 4 are met b. arrange for laboratory or diagnostic investigations c. discuss or inform the referring physician of results of diagnostic investigations.
    7. Documentation of the request and advice given must be recorded by the consultant in their patient records.
    8. This service may not be claimed for transfer of care alone.
    9. Advice to nurse practitioners may only be claimed if the nurse practitioner is in autonomous practice or working in a nursing station where no physician is present.
    Category:V Visit
    Base rate:$68.65

    AMA billing tips:

    • 03.01O is meant to compensate physicians for the time spent completing a consultation via electronic means. The intent is that the consultant would review the patients’ referral letter and work up and make recommendations about treatment to the referring physician without actually having seen the patient. You may use 03.01O only when you have completed the consultation using a secure electronic method such as secure electronic messaging, secure email or other secure electronic products that are accepted by the OIPC.

    • Effective Aug 24, 2017, when the criteria are met, physicians may submit claims for e-consultations when the referral is provided by a nurse practitioner in independent practice.

    Fee modifiers:

    No modifiers.

    Governing Rules: