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FFYFP Blog: Big Bucks: Better Billing

Written by: Dr. Tyler Hunter

You’re already taking time with every patient, phoning that family member on your lunch break and checking your labs on weekends. Money doesn’t solve everything, but you might as well get paid appropriately for your hard work.  


I want to start out with a few general billing tips that I think can help you bill more for the work you are already doing: 

  1. AMA’s Fee Navigator – Favorite this tab in your browser and use it! 
  1. Finish your billing on the day you do the work. I find that as I go through my completed clinic day and touch up notes, I remember additional tasks I completed for my patients. If I try to bill at the end of the week (or worse just before the 90-day deadline), the chance of me remembering to bill that I answered a pharmacist’s phone call or had a family conference in addition to the regular visit is very low.  
    • You actually get paid more if you submit your claim and invoice WCB Alberta on the day you saw the patient.  
  1. Write down or use a timer to take note of how long you are charting after seeing patients or researching information for a patient. Charting on the sofa with the game on? Looking up a differential on UpToDate? Checking old lab values on Netcare before seeing the patient? If this is on the same day you see the patient, all of the above are billable and likely lead to more complex care modifiers being billed. This is yet another reason to make sure you finish charting and billing on the day of the encounter whenever possible.  
  1. Most minor in clinic procedures are eligible to be billed along with a visit code. If you are using the fee navigator or want to double check – any procedure designated M+ can be billed with a visit code. For example, a skin biopsy can be billed 98.81A as well as a 03.03A (+/- CMGP). 
  1. If your clinic has a PCBH/therapist or diabetic nurse funded by the PCN or otherwise, set up a meeting with them quarterly to review the patients that you both take care of. Block off 15-30 minutes in your schedule and go through all of your shared patients. First and foremost, this ensures that the resource is being used for the right patients and that advice being given is cohesive. You can bill for the meeting time using 03.05JA or 03.05JD.  


Next, I wanted to share a few codes I learned about or started using more through my first 2.5 years of practice: 

  1. 03.01NM – Patient care advice to pharmacist. Pharmacy requests add up. Even if you aren’t going to fill the antibiotic they requested after being last filled 4 months ago, write back HARD NO and bill for it. Acknowledge receipt of the pharmacist directed short term fill notifications. You already had to read it and checked the patient’s chart to see if this was appropriate, so you might as well write a few words back and bill for it.  
  1. 03.01AD – I primarily use this when sending secure messages to patients through my EMR. When you review a normal set of labs for your patient, send them a message giving them an all-clear. This is good practice for closed-loop communication and not missing results. The few extra keystrokes take under a minute to bill $20 for the code. This code also doesn’t count against your daily cap! 
  1. 03.05JQ – Phone call with relative in connection to management of patient with psychiatric disorder. Did you just spend 15 minutes getting collateral on that depressed patient you saw today to ensure they could be sent home safely? Regular phone calls with family require 03.05JH to be billed, however if the patient has a psychiatric diagnosis, then the above code will net you almost triple (51.71 vs. 18.92).  
  1. BCP – For Alberta Health visits, these are likely added automatically via your EMR. However, for WCB visits, this must be entered as a second billing line. Sure, this code is only $3.00, but it also only takes 10 seconds to add to your invoice. If you are in Calgary/Airdrie, BCP02 is the code to be added to your WCB invoice. BCP01 is used for the rest of Alberta.  
  1. 03.04N – Comprehensive evaluation to determine capacity.  I see a lot of seniors, and overall, we have an aging population. This means more people developing mild cognitive impairment or dementia and more time-consuming capacity assessments. The above code bills $193.34 which is likely going to be more advantageous than billing a normal visit + CMGP.  

Billing efficiently and to the maximum within the guidelines is something that takes time and practice. Talk to your colleagues when something new comes up and make the Fee Navigator your friend.  

Enjoyed this article? Learn more by joining Norma Shipley on December 8 for BIlling Codes: Optimize billing effectiveness.  

7 Responses to “FFYFP Blog: Big Bucks: Better Billing”

  1. In relation to your point about 03.01ad, there is a 03.01s that may be also used for communication of results directly from physician to patient through a secure e communication portal.

  2. Hi,
    Thanks for the article.
    Is there a course to attend to be able to determine capacity for seniors?
    Can you bill for annual resident care conference for patients in continuing care like nursing homes? If yes , please what’s the code.

  3. Special note:
    After further consultation and discussions from the ACFP’s Webinar, “Billing Codes: How to optimize them”, it has come to our attention that the following is not the recommended practice and should Alberta Health perform an audit, you may be at risk of penalty.

    The recommended practice is to claim 03.01AD only when responding to patient-initiated, secure, asynchronous communication, or for direct contact with the patient by phone or videoconference when the physician’s time for direct and patient care management time on that day is <10 minutes. Why? The first note for 03.01AD states it may only be claimed “if the service was initiated by the patient or their agent (…as defined in the Personal Directives Act.”)

    03.01S would be a better choice for this type of physician-initiated communication as it may be initiated by the physician when there is an established physician-patient relationship and the physician has seen the patient in the previous 12 months. Be aware of the limitation of 14 services claimable per physician per week (Sunday through Saturday). 03.05JR (physician telephone call directly to patient) may also be used to report diagnostic text results to a maximum of 14 per week, but may not be claimed for the same patient by the same physician in the same week as 03.01S.

    For further information contact the AMA at

  4. Thank you for the article!
    I recently contacted AMA billing regarding the 03.05JA code for BHC/nursing staff providing care to our pts. They stated that we were not allowed to bill for PCN staff.
    Can you clarify further? Than you!

    • Posting on behalf of Dr. Hunter,

      You definitely can bill 03.05ja for a team conference involving a PCN nurse or behavioural health therapist. They are an allied health care staff member as required per the billing code. There is no parameter of who employs team member works for as a qualifier. The PCNs were also specifically told by the government that team conference time with these staff members was billable by physicians and this is the best code for that.

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