If you are completing a pre-operative history and physical examination, and you are not the physician performing the procedure, you may claim 03.04M (CMXC30 modifier, if applicable).
Please note that it is not appropriate to claim a consultation 03.08A for pre-operative history and physical examination.
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).
