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:

This may be used for an annual medical examination within the limitations of GR 4.6.1.
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.
Benefit includes the ordering of appropriate diagnostic tests and procedures as well as discussion with the patient.

Category:	V Visit
Base rate:	$40.14

AMA billing tips:

03.04A may not be claimed for registered hospital inpatients.
- 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.
- AHS and AH are conducting a review of physician overhead arrangements. Changes to the Z codes are expected to be implemented by October 1, 2020. In the meantime, there is still a requirement for physicians to claim the Z codes.
- Please consult the Alberta Health Facility Directory for information regarding facility designations.

Fee modifiers:

Type	Code	Explicit	Action	Amount
SKLL	ANES		Replace Base	$60.00
SKLL	ANPA		Replace Base	$81.68
SKLL	CARD		Replace Base	$96.75
SKLL	CLIM		Replace Base	$174.86
SKLL	CMSP		Replace Base	$174.86
SKLL	CRSG		Replace Base	$106.45
SKLL	CTSG		Replace Base	$106.45
SKLL	DERM		Replace Base	$46.84
SKLL	DIRD		Replace Base	$66.28
SKLL	E/M		Replace Base	$120.19
SKLL	EMSP		Replace Base	$53.92
SKLL	FTER		Replace Base	$53.92
SKLL	GAST		Replace Base	$88.69
SKLL	GNSG		Replace Base	$63.39
SKLL	GP		Replace Base	$104.60
SKLL	HEM		Replace Base	$174.86
SKLL	HEPA		Replace Base	$81.68
SKLL	IDIS		Replace Base	$129.98
SKLL	INMD		Replace Base	$174.86
SKLL	MDBI		Replace Base	$81.68
SKLL	MDGN		Replace Base	$120.24
SKLL	MDMI		Replace Base	$81.68
SKLL	MDON		Replace Base	$174.86
SKLL	NCMD		Replace Base	$66.28
SKLL	NEPH		Replace Base	$157.81
SKLL	NEUR		Replace Base	$148.40
SKLL	NPM		Replace Base	$120.24
SKLL	NUPA		Replace Base	$81.68
SKLL	NUSG		Replace Base	$53.54
SKLL	OBGY		Replace Base	$61.70
SKLL	OCMD		Replace Base	$174.86
SKLL	OPHT		Replace Base	$97.59
SKLL	ORTH		Replace Base	$61.53
SKLL	OTOL		Replace Base	$50.68
SKLL	OVAC		Replace Base	$97.59
SKLL	PATH		Replace Base	$81.68
SKLL	PDGE		Replace Base	$120.24
SKLL	PDNR		Replace Base	$148.40
SKLL	PDSG		Replace Base	$120.24
SKLL	PED		Replace Base	$120.24
SKLL	PEDC		Replace Base	$120.24
SKLL	PEDN		Replace Base	$157.81
SKLL	PHMD		Replace Base	$100.24
SKLL	PLAS		Replace Base	$90.69
SKLL	RHEU		Replace Base	$99.16
SKLL	ROSP		Replace Base	$104.60
SKLL	RSMD		Replace Base	$93.12
SKLL	THOR		Replace Base	$41.38
SKLL	UROL		Replace Base	$68.45
SKLL	VSSG		Replace Base	$40.14
CARE	CMXC30	Yes	Increase Base By	$31.43
TELE	TELES	Yes	Increase Base To	120%

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, 03.08CV, 03.08F, 03.08H, 03.08K, 08.11A, 08.11C, 08.19A, 08.19AZ, 08.19AA, and 08.19CX.
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:
- HSC 03.02A, 03.03A, 03.03AZ, 03.03B, 03.03BZ, 03.04A, 03.04AZ, 03.03DF or
- 03.03EA.

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Health Service Codes

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:

AMA billing tips:

Fee modifiers:

Governing Rules:

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