Governing Rules:

• 1.33

  An "in office" service is defined as a service that is not provided in the following publically funded facility types: Active Treatment Centre, Ambulatory Care Centre, Auxiliary Hospital, Health Canada Nursing Station, Community Ambulatory Care Centre, Community Mental Health Clinic, Nursing Home, Regional Contracted Practitioner Office and Subacute Auxiliary Hospitals. The following Health Service Codes are designated as "in office": 03.03A, 03.03B, 03.03F, 03.04A, 03.05I, 03.07A, 03.08A, 03.08B, 03.08I, 03.08J, 08.19A, 08.19G, 08.19GA, and 08.45.

  An "out of office" service is defined as a service that is provided in the following publically funded facility types: Active Treatment Centre, Ambulatory Care Centre, Auxiliary Hospital, Health Canada Nursing Station, Community Ambulatory Care Centre, Community Mental Health Clinic, Nursing Home, Regional Contracted Practitioner Office and Subacute Auxiliary Hospitals. The following Health Service Codes are designated as "out of office": 03.03AZ, 03.03BZ, 03.03FZ, 03.04AZ 03.05IZ, 03.07AZ, 03.08AZ, 03.08BZ, 03.08IZ, 03.08JZ, 08.19AZ, 08.19GZ, and 08.45Z

• 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, 03.08IV, 03.08IZ, 03.08J, 03.08JV, 03.08JZ, 03.08L, 03.08M, 08.19A, 08.19AZ, 08.19AA, 08.19B, 08.19BB, 08.19C, 08.19CC, and 08.19CX 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.