Fee Navigator®

    Health Service Code 03.04AZ

    Comprehensive assessment of a patient's condition requiring a complete history, a complete physical examination appropriate to the physician's specialty, an appropriate record and advice to the patient - out of office.

    NOTE:
    1. This may be used for an annual medical examination within the limitations of GR 4.6.1.
    2. Complete physical examination shall include examination of each organ system of the body, except in psychiatry, dermatology and the surgical specialties. "Complete physical examination" shall encompass all those organ systems which customarily and usually are the standard complete examination prevailing within the practice of the respective specialty. What is customary and usual may be judged by peer review.
    3. Benefit includes the ordering of appropriate diagnostic tests and procedures as well as discussion with the patient.
    Category:V Visit
    Base rate:$31.71

    AMA billing tips:

      • Physicians that provide care in publicly funded sites are required to bill the "Z" codes.
      • Publicly funded facility types are: acute care centres, ambulatory care centres, auxiliary hospital, Health Canada Nursing Station, nursing home, regional contracted practitioner office (offices that are contracted by AHS to provide specific services) and subacute auxiliary hospital.
      • Physicians that have an overhead arrangement with AHS and are required to bill the "Z" codes should get in touch with their Zone Medical Director to make arrangements to avoid "paying" overhead twice.
      • Please consult the Alberta Health Facility Directory for information regarding facility designations.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    SKLLANESReplace Base$60.00
    SKLLANPAReplace Base$55.54
    SKLLCARDReplace Base$66.76
    SKLLCLIMReplace Base$134.64
    SKLLCMSPReplace Base$134.64
    SKLLCRSGReplace Base$106.45
    SKLLCTSGReplace Base$106.45
    SKLLDERMReplace Base$38.41
    SKLLDIRDReplace Base$33.00
    SKLLE/MReplace Base$86.54
    SKLLEMSPReplace Base$53.92
    SKLLFTERReplace Base$53.92
    SKLLGASTReplace Base$70.07
    SKLLGNSGReplace Base$51.35
    SKLLGPReplace Base$90.21
    SKLLHEMReplace Base$134.64
    SKLLHEPAReplace Base$55.54
    SKLLIDISReplace Base$129.98
    SKLLINMDReplace Base$134.64
    SKLLMDBIReplace Base$55.54
    SKLLMDGNReplace Base$84.17
    SKLLMDMIReplace Base$55.54
    SKLLMDONReplace Base$134.64
    SKLLNCMDReplace Base$33.00
    SKLLNEPHReplace Base$134.14
    SKLLNEURReplace Base$115.75
    SKLLNPMReplace Base$84.17
    SKLLNUPAReplace Base$55.54
    SKLLNUSGReplace Base$40.69
    SKLLOBGYReplace Base$48.74
    SKLLOCMDReplace Base$134.64
    SKLLOPHTReplace Base$78.07
    SKLLORTHReplace Base$49.84
    SKLLOTOLReplace Base$42.06
    SKLLOVACReplace Base$78.07
    SKLLPATHReplace Base$55.54
    SKLLPDGEReplace Base$84.17
    SKLLPDNRReplace Base$115.75
    SKLLPDSGReplace Base$84.17
    SKLLPEDReplace Base$84.17
    SKLLPEDCReplace Base$84.17
    SKLLPEDNReplace Base$134.14
    SKLLPHMDReplace Base$78.19
    SKLLPLASReplace Base$62.58
    SKLLRHEUReplace Base$66.44
    SKLLROSPReplace Base$62.76
    SKLLRSMDReplace Base$77.29
    SKLLTHORReplace Base$31.86
    SKLLUROLReplace Base$54.76
    SKLLVSSGReplace Base$31.71
    CARECMXC30YesIncrease Base By$31.43
    TELETELESYesIncrease Base To120%

    Governing Rules:

    • 1.33

      An "in office" service is defined as a service that is not provided in the following publically funded facility types: Active Treatment Centre, Ambulatory Care Centre, Auxiliary Hospital, Health Canada Nursing Station, Community Ambulatory Care Centre, Community Mental Health Clinic, Nursing Home, Regional Contracted Practitioner Office and Subacute Auxiliary Hospitals. The following Health Service Codes are designated as "in office": 03.03A, 03.03B, 03.03F, 03.04A, 03.05I, 03.07A, 03.08A, 03.08B, 03.08I, 03.08J, 08.19A, 08.19G, 08.19GA, and 08.45.

      An "out of office" service is defined as a service that is provided in the following publically funded facility types: Active Treatment Centre, Ambulatory Care Centre, Auxiliary Hospital, Health Canada Nursing Station, Community Ambulatory Care Centre, Community Mental Health Clinic, Nursing Home, Regional Contracted Practitioner Office and Subacute Auxiliary Hospitals. The following Health Service Codes are designated as "out of office": 03.03AZ, 03.03BZ, 03.03FZ, 03.04AZ 03.05IZ, 03.07AZ, 03.08AZ, 03.08BZ, 03.08IZ, 03.08JZ, 08.19AZ, 08.19GZ, and 08.45Z

    • 4.6.1

      Comprehensive visits and/or comprehensive/major consultations may only be claimed once every 365 days per patient by the same physician. Comprehensive visit and consultation services are defined as HSCs 03.04A, 03.04AZ, 03.08A, 03.08AZ, 03.08B, 03.08BZ, 03.08C, 03.08F, 03.08H, 03.08K, 08.11A, 08.11C, 08.19A, 08.19AZ and 08.19AA.

      HSC 03.09B is defined as comprehensive and may not be billed more frequently than once every 180 days by the same physician.

      HSCs 03.04O and 03.04P are defined as comprehensive services and may not be billed more frequently than four times per year as indicated or within 180 days of a comprehensive service or consultation by the same physician.

    • 5.2.3

      Services provided to additional patients seen during the same callback, or services over the limits specified in GR 15.11 may be claimed as:

      1. Deleted
      2. HSC 03.02A, 03.03A, 03.03AZ, 03.03B, 03.03BZ, 03.04A, 03.04AZ as appropriate, or
      3. the applicable procedure.
    • 9.1.1

      The following examinations are included in the complete examination (03.04A, 03.04AZ, 03.08A, 03.08AZ, 03.08H, 09.04) and may not be claimed in addition:

      • Measurement of vision
      • Refractive error
      • Extra-ocular muscle balance
      • 03.12A Intra-ocular pressure measurement
      • 09.01A Biomicroscopy (slit lamp examination)
      • Retinal examination
    • 9.1.2

      Three technical services and three interpretive services from the following examinations may be claimed in addition to HSCs 03.04A, 03.04AZ, 03.08A, 03.08AZ, 03.08H and 09.04:

      • 09.01B Gonioscopy
      • 09.01C Orthoptic analysis, interpretation
      • 09.01E Orthoptic analysis, technical (may include Hess screen)
      • 09.02B Anterior chamber depth measurement
      • 09.02E Amblyopia evaluation for patients nine years of age or younger
      • 09.05A Full threshold perimetric examination, technical
      • 09.05B Full threshold perimetric examination, interpretation
      • 09.06A Color vision test, interpretation and technical
      • 09.11A Bilateral specular microscopy for corneal graft patients only - technical
      • 09.11B Bilateral specular microscopy for corneal graft patients only - interpretation
      • 09.11C Potential acuity measurement (PAM)
      • 09.12A Intravenous fluorescein angiography (IVFA), interpretation
      • 09.12B Intravenous fluorescein angiography (IVFA), technical

      09.13E Optical coherence tomography (OCT), interpretation 09.13F Optical coherence tomography (OCT), technical 09.26A Diurnal tension curve 09.26D Bilateral corneal pachymetry 21.31A Diagnostic irrigation of nasolacrimal duct, office procedure, per eye 24.89B Diagnostic conjunctival scraping 25.81A Diagnostic corneal scraping

    • 10.4.1

      Pre-operative services shall be claimed under the appropriate hospital or office visit HSCs (generally HSCs 03.03A, 03.03AZ, 03.04A, 03.04AZ, 03.04C, 03.04M) and;

    • 15.5

      Only one unscheduled service or special callback benefit may be claimed for each encounter with a patient. In the event of a special callback, the following visit services may be claimed in addition: