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 (excluding consultations) related to the procedure either before or after the procedure are considered to be related to the procedure and are therefore not billable.
Post-operative complications and conservative measures (hospital inpatients only) before surgery (as part of an effort to avoid surgery) are the exception to this rule.
For example, a patient who is admitted to hospital under conservative care intended to avoid surgery might ultimately need to have surgery. You can bill pre-operative visits to that patient to the Alberta Health Care Insurance Plan (giving brief details of the situation).
Post-operative complications can also be billed to AHCIP (with an explanation of the situation and the need for post-operative visits within the inclusive-care period).
