Post-operative complications are billable to Alberta Health and Wellness.
Every health service code (HSC) in the Schedule of Medical Benefits (SOMB) is assigned a category code. Procedures with a category code of 1-15 are assigned a pre-operative and post-operative period; also called the inclusive care period. Visits related to the procedure within the inclusive care period are considered to be part of the surgical benefit, therefore they are not billable to Alberta Health Care Insurance Plan (AHCIP).
Visits for (1) conservative measures (in hospital only) prior to surgery (in an effort to avoid surgery) and (2) post-operative complications are the exceptions to this rule.
For example, if a patient is admitted to the hospital under conservative orders intended to avoid surgery and then ultimately has to have surgery, the pre-operative visits can be billed to the AHCIP. These claims will require text giving brief details of the situation and the need for pre-operative visits.
Post-operative complications, in or out of hospital, can also be billed to AHCIP with text to explain the situation and the need for post-operative visits within the inclusive care period.
Routine post-operative visits (e.g., wound management) are not billable to AHCIP. Remember that WCB services are unbundled and all visits related to the procedure are billable to WCB.
