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    Health Service Code 03.08J

    Prolonged consultation or hospital admission by pediatrics (including subspecialties) and clinical immunology and allergy for patients 18 years of age and under, or by medical genetics (no age restriction), full 15 minutes or portion thereof for the first call when only one call is claimed

    NOTE:

    May only be claimed:

    Common terms:
    • 18 years of age
    Category:V Visit
    Base rate:$60.12

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    CALLM151 - 10For 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.