Special Service Codes Table 3
Code System = http://pharmacyeclaims.ca/FHIR/CodeSystem/special-service-codes
Value Set = http://pharmacyeclaims.ca/FHIR/ValueSet/special-service-codes
**Incomplete - ** Discussed with TWG on March 14th but further info required..
** Are these submitted in addition to the DIN??? There is a compound rule that suggests may be the case; you do not always have a DIN** Review to determine if all are modifiers - I believe this is YES.
The Special Service Code (SSC) describes a service which has been provided in accordance with a benefit plan or agreement In the current CPHA specification, it is also used to identify claims where the cost of the medication prescribed exceeds $9999.99. As FHIR allows for any number to be specified, these codes will be deprecated.
FHIR Mapping: Claim.item.productService code
TABLE 3, CPHA D.57.03 SSC
Table 3 contains SPECIAL SERVICE CODES to be used by the provider, in Field D.57.03 to claim compensation for special services provided. These codes will usually apply to the provision of Professional Services. In naming this
table we have used the field name originally assigned to Field D.57.03.
This field uses single character codes but
can use up to three codes in a transaction, allowing the provider to claim more than one service respecting a prescription or consultation. Current codes in this field are numeric and cover a number of general services which
pharmacists may provide.
Other Codes and Code Values may be added as has been indicated in the comments for Tables 1 and 2. Field D.57.03, SSC has an Alpha/Numeric code format and a single code length. Two numeric characters and the alphabet up to and including "U" are available for additional codes. Codes V to Z have been designated for "Table 5". *Anne to create code system/value set for these codes once codes are final
| Code | Description | Discussion Notes | Alberta? | |
|---|---|---|---|---|
| 1 | refusal to fill a prescription | Professional service | ||
| 2 | pharmacist intervention | explain pls? | ||
| 3 | pharmacist consultation | Professional service | ||
| 4 | referral by pharmacist | Professional service | ||
| 5 | approved home care services | explain pls? | Alberta - FacilityLiving | |
| 6 | Drug Utilisation Review (DUR) | Professional service | ||
| 7 | co-ordination of benefit | do we need this? | ||
| 8 | claiming multiple dispensing fees | |||
| 9 | narcotic & controlled drug monitoring | |||
| A | special delivery of parenteral therapy | |||
| B | special delivery of ophthalmic solution | |||
| C | special packaging of parenteral therapy | |||
| D | special packaging of ophthalmic solution | |||
| E | claiming professional care services | Professional service | ||
| F | renew previous prescription | meaning pls? | ||
| G | 7 day pill pack modification | |||
| H | adapt prescription to current need | |||
| I | prescribed emergency supply of medication | |||
| J | medication administered by injection | |||
| K | prescribed “initial supply” of medication | |||
| L | initial assessment of patient’s need | |||
| M | follow-up assessment of patient’s need | |||
| N | short term dispense modified fee | |||
| O | short term dispensing fee | |||
| P | 7 day pill pack | Alberta | ||
| Q | solid oral dosage forms | |||
| R | partial claim, cost exceeds $9999.99 | Deprecate | ||
| S | remainder of claim, cost exceeds $9999.99 | Deprecate | ||
| U | No-Private-Insurance Attestation | |||
| W | PhysicalImpairmentSensoryImpairment | Alberta | ||
| X | EMentalCognitiveImpairement | Alberta | ||
| Y | Medication Safety | Alberta |
Following codes used in other provinces except Alberta
| Code | Description | Discussion Notes | Alberta? |
|---|---|---|---|
| W | Emergency Contraception consultation level 1 | Professional service | |
| X | mergency Contraception consultation level 2 | Professional service | |
| Y | Emergency Contraception consultation level 3 | in place of DIN? |
there are other codes in the appendix, where there are only codes 1-8 listed????
For Provider Use - Field D.57.03
(updated March 1996)
TABLE 5, CPHA D.57.03 SSC
Table 5 contains the LEVEL OF SERVICE CODES. These codes will allow the provider to claim appropriate compensation from one of five ranges of professional service values. To implement use of the codes in this table will require that the provider and payor come to an understanding regarding the services and reimbursement amount for the services within each range. These codes will be assigned in Field D.57.03. and included in the March '96 update of the Standard. In order to make as many codes as possible available to "Table 3" there will be no provision for the assignment of additional Level of Service Codes or Values. As is indicated in the comments on Table 3, the use of a code contained in this table becomes one of three possible messages communicated via field **D.57.03, SSC** in a single transaction
LEVEL OF SERVICE SHOULD BE DEPRECATED - CONFIRM WITH TWG
| CODE | VALUE | DEPRECATE? |
|---|---|---|
| V | Level 1 Service | |
| W | Level 2 Service | |
| X | Level 3 Service | |
| Y | Level 4 Service | |
| Z | Level 5 Service |
Note: Increase in Numeric Value Level Represents an Increased Service Value
Alberta Blue Cross from Lamar - May 3 -- ABC to review, provide definitions for each via email. Anne will then update this section. Please identify older codes as deprecated.
Code System = Alberta Blue Cross
1 - RefusalToFillAnRx
2 - PharmacistIntervention
3 - PharmacistConsultation
4 - ReferralByPharmacist
5 - FacilityLiving
6 - DrugUtilizationReview
7 - CoordinationOfBenefit
8 - ClaimingMultipleDispensingFees
9 - NarcoticAndControlledDrugMonitoring
A - SpecialDeliveryOfParentaralTherapy
B - SpecialDeliveryOfOpthalmicSolution
C - SpecialPackagingOfParentaralTherapy
D - SpecialPackagingOfOpthalmicSolution
E - ProfessionalCareServiceClaim
F - RenewPreviousPrescription
G - SevenDayPillPackModification
H - AdaptPrescriptionToCurrentNeed
I - PrescribedEmergencySupplyOfMedication
J - MedicationAdministeredByInjection
K - PrescribedInitialSupplyOfMedication
L - InitialAssessmentOfPatientsNeed
M - FollowUpAssessmentOfPatientsNeed
N - ShortTermDispenseModifiedFee
O - ShortTermDispensingFee
P - 7DayPillPack
Q - SolidOralDosageForms
R - PartialClaimCostExceeds9999
S - RemainderClaimCostExceeds9999
W - PhysicalImpairmentSensoryImpairment
X - EMentalCognitiveImpairment
Y - MedicationSafety
Alberta PHAP - do we include in the spec as codes specific to Alberta?
Code System = Alberta PHAP|Notes
1 - RefusalToFill|Note To ABC - there is another mechanism for refuse to fill in the spec|
3 - MAID
F - RenewPreviousPrescription
H - AdaptPrescriptionToCurrentNeed
I - PrescribedEmergencySupplyOfMedication
J - MedicationAdministeredByInjection
K - PrescribeInitialSupplyOfMedication
L - InitialAssessmentOfPatient
M - FollowUpAssessmentOfPatient
In CPHA, these codes are also used to identify claims where the cost of the medication prescribed exceeds $9999.99. TWG DISCUSSION - CONFIRM REMOVAL; NO LONGER REQUIRED IN FHIR but may exist until all carriers can natively support a single claim with amount over 9999
Codes R and S ;-REMOVE
“Code R” messages will identify claims for values that exceed $9999.99 (the maximum amount that the Pharmacy Claim Standard can report in a single message).
“Code S” messages will indicate the amount(s) that exceeds $9999.99, or that exceed multiples of $9999.99. This code (S) must only be used where a “Code R” has been used, but a balance of the cost still remains. Continue to send code “S” claims messages until the full amount of the claim is covered.