Professional Service Codes

Refer to Special Service Code Listing, to determine the codes that will be supported.'

Categories of Services Patient Assessment/Medication Review/Meds Check

• variances by time period, every province sets a list of codes/pseudo DINS, variances by medical condition
  

Adaptation

• Prescription from Doctor; pharmacy changes the prescription
• Pharmacy can bill for an adaptation; cross reference of the dispense of the medication (**Anne to ensure there is a link to do this)
• Therapeutic Substitution
  

Refusal to Fill/Return to Stock

• compelling reason to not give to the patient (eg fraud, patient in hospital, etc)
• Meds must be put back into stock; pharmacy has spent time doing this so some provinces/plans will cover
  

Immunization/Admin Fee

• Pharmacy charges for the injection above the cost of the medication
• In some cases, the drug is free to the pharmacy; only the injection is covered
• These are two claims in some cases, and in other provinces, it is only ONE claim.
• We should have separate claims; one for the medication and a second for the immunization. It could be different pharmacists on the dispense and the injection
• should be linked
• pharmacy tracks the body site and route (are these required by adjudicators???)
  

Consultation Fee

• Smoking Cessation
• Similar to Med review with separate PINS and rules around it
  

Extension/Prolongation/Pharmacy Renewal

• If medications run out and the doctor is unavailable, the pharmacy can extend the prescription by giving an additional refill
• Pharmacy bills for this as it would otherwise be a visit to the doctor
• May cross-reference to the medication

Pharmacist Opionon - Pharmacy reviews medication and shared their opinion with the doctor - Some provinces allow billing for sharing the opinion - with or without a fee; even those that allow for it, provinces may want the claim for tracking purposes

Emergency Transport

• Sending medicaitons to a patient with critical need
• Pharmacy rushes this
• May be linked to the dispensed med claim
  

Minor Ailment Service

• Medical condition that can be addressed by the pharmacist
• eg UTI, code sores,etc; this list varies by province
• Minor ailments must be codified
• Optional - may want a reference to the original "diagnosis" or a reference to the original "prescription" number
• Pharmacy is allowed to charge for the "service" - which includes speaking with the patient and sometimes includes a prescription and dispense
• Dispense claim is separate but may be linked

Compliance Packaging Fee

• Additional fee to package a medication in compliance packaging

Patient Training Fee

• Consult specifically to use a new medication, eg inhaler

Existing List of PINS

Alberta Patient Assessment
Alberta PHAP
Alberta PPMI
BC Adaptation
BC Medication Review
BC Refusal To Fill
COVID19 Immunization Administration Fee
General Fee For Service
Green Shield Smoking Cessation
Influenza Immunization Administration Fee
Minor Ailment Assessment
NB PharmaCheck
NL Adaptation
NL Extension
NL Medication Review
NL Refusal To Fill
NS Advanced Medication Review
NS Basic Medication Review
NS Refusal To Fill
NS Rx Adaptation
NS Therapeutic Substitution
Non-Influenza Immunization Administration Fee
ODB Expanded Services
ODB Meds Check
ODB Smoking Cessation Payment
ODB Smoking Cessation Program Evaluation
PEI PharmaCheck
RAMQ Emergency Transport
RAMQ Minor Ailment No Diagnosis
RAMQ Minor Ailment With Diagnosis
RAMQ Pharmacy Opinion
RAMQ Professional Service
RAMQ Refusal To Fill RAMQ Rx Adaptation RAMQ Rx Extension Refusal To Fill Return To Stock SPDP Alternate Fee SPDP Compliance Packaging Fee SPDP ECP Fee SPDP Med Assessment SPDP Pact - ??? SPDP PrescriptiveAuth -- minor ailment,assessment or adaptation? SPDP Refusal To Fill SPDP Seamless Care -- ?? Therapeutic Injection Administration Fee

Training -