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    Health Service Code 03.08I

    Prolonged cardiology, clinical immunology, endocrinology/metabolism, gastroenterology, hematology, infectious diseases, internal medicine, nephrology, physiatry, medical oncology, neurology, respiratory medicine or rheumatology consultation or visit, full 15 minutes or major portion thereof for the first call when only one call is claimed

    NOTE:

    May only be claimed in addition to HSCs 03.04A, 03.04C, 03.07B and 03.08A when these services exceed 30 minutes.

    Category:V Visit
    Base rate:$40.24

    AMA billing tips:

    • The rate of $12.45 for CARD is not an error, but an achievable first step of the implementation of the CARD skill code for this service, using funds available to the section for the November 1, 2018 changes. It is expected that the rate will increase significantly in accordance with the sections’ INRV’s in the future.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    SKLLCARDReplace Base$12.45
    SKLLCLIMReplace Base$47.69
    SKLLE/MReplace Base$54.63
    SKLLGASTReplace Base$42.75
    SKLLHEMReplace Base$47.69
    SKLLIDISReplace Base$49.99
    SKLLINMDReplace Base$47.69
    SKLLMDONReplace Base$47.69
    SKLLNEPHReplace Base$42.85
    SKLLNEURReplace Base$45.51
    SKLLPHMDReplace Base$50.12
    SKLLRHEUReplace Base$40.24
    SKLLRSMDReplace Base$44.96
    CALLM151 - 6For Each Call Pay Base At100%
    TELETELESYesIncrease Base To120%

    Governing Rules:

    • 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.

    • 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.

    • 4.4.1

      In this Schedule "consultation" means that situation where a physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner after an appropriate examination of the patient, requests the opinion of a consultant physician, and the consultant does a history, an examination and a review of the diagnostic data and provides a written opinion with recommendations as to the treatment, to the referring physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner. Consultations may not be claimed for the transfer of care alone.

    • 4.4.2

      The need for a consultation can arise as a result of the following:

      1. some unusual or serious clinical problem,
      2. a physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner requires further advice regarding diagnosis or management or both, or
      3. the patient, parent or guardian requests another opinion.