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    Health Service Code 03.04R

    Pre-surgical planning and patient navigation visit

    NOTE:
    1. May only be claimed by general surgery.
    2. May only be claimed for patients that have already received a consultation in the pre-operative period by the same physician who intends on performing the procedure.
    3. May only be claimed in instances where more than one pre-surgical visit is necessary due to the complexities of the patients' circumstances and/or surgical needs.
    4. May only be claimed in the pre-operative period for procedures with a category code of 3, 4, 6 or 14.
    Category:V Visit
    Base rate:$79.23

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    SKLLGNSGReplace Base$79.23
    SKLLPDSGReplace Base$79.23

    Governing Rules:

    • 6.8.1

      HSCs with a designated category code of 1 and 15 include related post-operative services and those with a designated category code of 3, 4, 6 and 14 include both related pre-operative and post-operative services.

      1. a consultation benefit may be claimed up to and including the day of surgery.
      2. pre-operative hospital care may be claimed by the physician who performs the surgery if information is submitted to show that conservative treatment was attempted before surgery was performed.
      3. benefits may be claimed as applicable for complications occurring during or following post-operative time periods.
      4. Deleted
      5. HSC 03.04R may be claimed in the pre-operative time frame when all conditions in the notes have been met.

      The following chart gives the pre-operative and post-operative periods.

      CategoryPre-operativePost-operative
      10 - Days14 - Days
      37 - Days7 - Days
      47 - Days14 - Days
      614 - Days14 - Days
      1430 - Days14 - Days
      150 - Days7 - Days