Long-term care forms, admission and placement, 03.04D

Criteria:

All of the following criteria must be met:

• Different steps are involved in having someone admitted to a long-term care facility.
• Typically, the placement is followed by admission (when a bed becomes available). These events occur on different dates of service.

Placement:

• Requires an examination and form completion.
• This should be submitted as a visit service appropriate to the visit provided, i.e., 03.03A, 03.04A (if a 03.04A hasn’t been claimed in the last 365 days), 03.03N, etc.
• Complex modifiers apply when time criteria are met.
• Time spent completing the forms on the same day the visit occurs may be included in the total time submitted for complex modifiers.
• There are no additional fees for form completion, and fees cannot be charged to the patient for completing the forms.

Admission:

• Admission occurs the day the patient is admitted to the long-term care facility.
• This process requires the physician to complete all components of the admission to the facility. There is nothing billable to the patient.
• The code to claim for the admission is:
  • 03.04D long-term care admission (nursing home/auxiliary hospital or a long-term care bed in a general hospital). 

Additional information:

• Admission 03.04D would take place at the facility.
  • Use the facility code associated with the facility when submitting claims for this service.
  • For more information, refer to the Alberta Health's resource:
    Facility Listing – Numbers and Functional Centre Codes