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