03.01AD for COVID-19

March 18, 2020

On March 12, 2020 Alberta Health announced the use of the03.01AD code to support physicians providing care to patients during the COVID-19 pandemic. For detailed information about using the code read the AHCIP Bulletin MED 221:

HSC

HSC Description

Rate

03.01AD

Telephone advice to a patient or their agent (“agent” as defined in the Personal Directives Act) during a viral epidemic.

  1. May only be claimed when a declaration of a public health emergency is made pursuant to 52.1(1), of the Public Health Act, or when the Chief Medical Officer of Health determines, in their discretion, that it is appropriate to implement this health service code even though a public health emergency has not been declared.
  2. May only be claimed once per patient, per physician, per day.
  3. Benefit includes providing a new prescription or prescription renewal if provided.
  4. May not be claimed for providing general information on the virus.
  5. May not be claimed for services provided through Health Link.
  6. Documentation of the request and advice given must be recorded.
  7. May only be claimed when communication is provided by the physician.

$20.00

"V" Category Code

Important information about claims:

  • For tracking purposes, the diagnostic code that must accompany the claim is 079.82 if it is COVID-19 related.
  • If your billing software can only accommodate one decimal place, you may submit the claim using 079.8 which is not accurate but will be accepted.
  • If the physician and or the patient are exercising social distancing, the 03.01AD may be claimed to address ANY medical condition using 03.01AD. For example, the patient is calling the physician instead of coming in to discuss diabetes, or management of their other medical conditions NOT related to COVID-19. The reason that the call is taking place instead of an in person visit is due to COVID-19 therefore the first Dx code on the claim must be 079.82 or 079.8, the second Dx code on the claim must reflect the other medical condition.
  • May only be billed when the physician provides the phone call
  • Only one per patient per physician per day
  • Billed using the PHN of the patient
  • Use the location of the physician at the time of the call
  • Document the call, the request that was made and the advice given and to whom the advice was given
  • May not be billed:
    • For general information about the virus
    • When leaving a message
    • When the nurse provides the service
    • In addition to any other service provided on the same day for the same patient
    • If a call is transferred to the physician through Health Link

Common Questions

Are there limitations to the number of 03.01AD services that I can bill in the same day?

No, there are no limitations to the number of 03.01AD that can be billed by a physician.

If a patient is seen in the office earlier in the day and calls later the same day regarding COVID-19 can I bill for both services?

No, you may only bill for either the visit or the phone call but not both.

Can I bill for two phone calls in the same day for the same patient for two different problems one for COVID-19 and the other for an unrelated issue?

No, you may only use one phone call code per patient, per physician per day.

Are there any modifiers (CMGP, CMXV15/20) on the 03.01AD?

No, there aren’t any modifiers on the 03.01AD code, it is a standalone code.

Can I bill for more than one call when the services take a long time or when I am dealing with mental health issues?

No, only one call is billable per day.

Are there other changes to rules for billing for physician to physician phone calls, phone calls, videoconferences and emails to patients, or relaxing of other restrictions?

No, at this time, the rules limiting the number of these services that may be claimed per week are still in place.

Are there changes to other health services codes (e.g., visits, consultations, psychotherapy) that allow them to be claimed for remote delivery?

No, at this time, the requirements for in-person delivery of these services are still in place, and these services must only be claimed when there is direct, in person contact between physician and patient.

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