This modifier type is used to indicate a complex patient visit payable in time units by general practitioners only.
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When claiming a procedure and a visit service at the same encounter, the time spent completing the procedure cannot be used to calculate the time for complex modifiers (CMGP, CMXV, CMXC). For example, a patient might ask a physician to examine a sebaceous cyst, and the physician decides to excise the cyst.
If the time spent examining the cyst was under 15 minutes, and the time removing the cyst took 25 minutes, the claim to the Alberta Health Care Insurance Plan could look like: 03.03A and 98.12C.
The complexity modifier could not be claimed, as the time spent delivering the visit portion of the service was under 15 minutes.
| Code: | Description: |
|---|---|
| CMGP | COMPLEX PATIENT VISIT Explicit This modifier is used to indicate a complex patient visit requiring that the physician spend 15 minutes or more on management of the patient's care. EACH ADDITIONAL UNIT REPRESENTS 10 MINUTES. ADDITIONAL UNITS MAY NOT BE CLAIMED UNLESS A FULL 10 MINUTES HAS ELAPSED. (Example: CMGP03 indicates a general practice physician has spent a minimum of 35 minutes with the patient and on patient management activities. The first unit represents 15 minutes and each subsequent unit represents 10 minutes.) A maximum of 10 calls may be claimed for HSCs 03.01J, 03.03A, 03.03AZ, 03.03B, 03.03BZ, 03.03C, 03.03N, 03.03NA, 03.03NB, 03.03P, 03.03Q, 03.07A, 03.07AZ, and 03.07B by general practitioners. A maximum of 1 call (CMGP01) may be claimed for HSC 03.03CV by general practitioners. |
