Criteria:
All of the following criteria must be met:
- A patient is required to have a pre-operative examination and history before receiving treatment for an insured service.
- The physician performing the pre-operative examination is not the physician performing the procedure within the inclusive care period of the procedure.
These fee codes may not be claimed for the following:
- May not be claimed by the anesthetist performing the anesthetic for the procedure (this is considered to be part of the pre-anesthetic evaluation) (GR 12.2).
- 12.2: The anesthetic benefit listed is for professional services, including pre-evaluation and post-anesthetic follow-up and all immediate supportive measures.
Additional information:
- Pre-operative physicals may not be claimed as consultations.
- 03.04M is considered a visit service and, therefore, cannot be claimed by the operating physician within the inclusive care period (category procedures 1-15).
- In the case where the operating surgeon does the pre-operative history and physical examination, it could be considered part of a consultation (03.07A, 03.07B, 03.07C, 03.08A), as appropriate and in accordance with the Governing Rules.
- If a physical and/or examination was not completed, nothing can be claimed.
- 03.04M is not billable to the Alberta Health Care Insurance Plan when it is in relation to an uninsured service. A pre-operative history and physical for dental procedures are only payable if the dental anesthetic is an insured service (GR 10).
Governing rules:
12.2, 10