Fee Navigator

    Governing Rule: 4.3

    CONSULTATIONS - DEFINITIONS

    • 4.3.1

      Comprehensive Consultation: An in-depth evaluation of a patient with a written report to the referring physician, audiologist, Alberta registered midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner. This service includes the recording of a complete history, performing a complete physical examination appropriate to the physician's specialty, an appropriate record and advice to the patient. It may include the ordering of appropriate diagnostic tests and procedures as well as discussion with the patient and/or the referring physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner.

    • AMA billing tips:

      • Consultations may only be claimed when ALL of the following criteria have been met:

        • Patient is examined by referring provider (full list G.R. 4.4.1)
        • Referring provider specifically requests (verbal or written)opinion and or advice of consultant
        • Consultant performs:
        1. full history and
        2. full physical (relative to their specialty)
        3. may order lab or diagnostics.
        4. discusses treatment and advice with the patient and in some cases the referring provider
        5. provides referring provider with written report about recommendations, treatment, opinion.

        Consultations may NOT be claimed for transfer of care or pre operative assessments.

        Consultations are billable up to and including the day of surgery.

    • 4.3.2

      Limited Consultation: Limited assessment of a patient and a written report to the referring physician, audiologist, Alberta registered midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner. A limited consultation includes a history limited to and related to the presenting problem, and an examination which is limited to relevant body systems, an appropriate record, and advice to the patient. It may include the ordering of appropriate diagnostic tests and procedures as well as discussion with the patient and/or the referring physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner.

    • AMA billing tips:

      • Consultations may only be claimed when ALL of the following criteria have been met:

        • Patient is examined by referring provider (full list G.R. 4.4.1)
        • Referring provider specifically requests (verbal or written)opinion and or advice of consultant
        • Consultant performs:
        1. full history and
        2. full physical (relative to their specialty)
        3. may order lab or diagnostics.
        4. discusses treatment and advice with the patient and in some cases the referring provider
        5. provides referring provider with written report about recommendations, treatment, opinion.

        Consultations may NOT be claimed for transfer of care or pre operative assessments.

        Consultations are billable up to and including the day of surgery.

    • 4.3.3

      Time Based Consultations: Notwithstanding GRs 4.3.1 and 4.3.2, claims for consultation services as defined under HSCs 03.08F, 03.08I, 03.08J, 03.08L, 03.08M, 08.19A, 08.19AA, 08.19B, 08.19BB, 08.19C, and 08.19CC may be claimed on a time basis.

    • AMA billing tips:

      • Consultations may only be claimed when ALL of the following criteria have been met:

        • Patient is examined by referring provider (full list G.R. 4.4.1)
        • Referring provider specifically requests (verbal or written)opinion and or advice of consultant
        • Consultant performs:
        1. full history and
        2. full physical (relative to their specialty)
        3. may order lab or diagnostics.
        4. discusses treatment and advice with the patient and in some cases the referring provider
        5. provides referring provider with written report about recommendations, treatment, opinion.

        Consultations may NOT be claimed for transfer of care or pre operative assessments.

        Consultations are billable up to and including the day of surgery.

    • 4.3.4

      Psychiatric Consultation referred by other professions: A benefit for a psychiatric consultation (HSCs 08.19AA, 08.19BB, 08.19CC) may be claimed when a patient is referred to a psychiatrist by a registered: occupational therapist, psychologist, community based psychiatric nurse, social worker or speech language pathologist and the provisions that apply to consultations under GRs 4.3, 4.4 and 4.6 are met.

    • AMA billing tips:

      • Consultations may only be claimed when ALL of the following criteria have been met:

        • Patient is examined by referring provider (full list G.R. 4.4.1)
        • Referring provider specifically requests (verbal or written)opinion and or advice of consultant
        • Consultant performs:
        1. full history and
        2. full physical (relative to their specialty)
        3. may order lab or diagnostics.
        4. discusses treatment and advice with the patient and in some cases the referring provider
        5. provides referring provider with written report about recommendations, treatment, opinion.

        Consultations may NOT be claimed for transfer of care or pre operative assessments.

        Consultations are billable up to and including the day of surgery.