Pre-operative History and Physical Examination, 03.04M

Criteria:

All of the following criteria must be met:

  • A patient is required to have a pre-operative examination and history before receiving treatment for an insured service.
  • The physician performing the pre-operative examination is not the physician performing the procedure within the inclusive care period of the procedure. 

This fee code may not be claimed for the following:

  • May not be claimed by the anesthetist performing the anesthetic for the procedure (this is considered to be part of the pre-anesthetic evaluation) (GR 12.2).
    • 12.2: The anesthetic benefit listed is for professional services, including pre-evaluation and post-anesthetic follow-up and all immediate supportive measures.

Additional information:

  • Pre-operative physicals may not be claimed as consultations.
  • 03.04M is considered a visit service and, therefore, cannot be claimed by the operating physician within the inclusive care period (category procedures 1-15).
  • In the case where the operating surgeon does the pre-operative history and physical examination, it could be considered part of a consultation (03.07A, 03.07B, 03.07C, 03.08A), as appropriate and in accordance with the Governing Rules.
  • If a physical and/or examination was not completed, nothing can be claimed.
  • 03.04M is not billable to the Alberta Health Care Insurance Plan when it is in relation to an uninsured service. A pre-operative history and physical for dental procedures are only payable if the dental anesthetic is an insured service (GR 10).

Governing rules

12.2, 10

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