Pre-Scheduled Surgical Services – Visit Fees

Doctors Manitoba recommends that, when you perform a surgical procedure on a “pre-scheduled basis”, if it is medically necessary for you to examine the patient prior to performing the procedure you should:

  1. Submit a claim under the appropriate visit tariff, in addition to your claim for the surgical service;
  2. Indicate on your claim that you examined the patient prior to performing the surgical service and the reason that such an examination was medically necessary; and
  3. If you have failed to include such remarks on your claim, and your claim for a visit fee has been rejected, query the claim, and indicate on your query that you examined the patient prior to performing the surgical service and the reason that such an examination was medically necessary.

Billing Notes:

  • There is no “hard and fast” rule as to when it is “medically necessary” to examine a patient on the same day as a pre-scheduled surgical service, and each case must be decided on its own merits.
  • However, there is a consensus between Doctors Manitoba and Manitoba Health that, in order to qualify for a visit fee, the nature of the examination must be more extensive or significantly different in nature than a standard identification of the patient/surgical site.

If you perform an examination on the same date as a pre-scheduled surgical service, it is recommended that you document in the patient chart both the nature/extent of the examination and the reason/medical necessity for the examination. This documentation will be extremely valuable in the event that Manitoba Health should audit any of your claims for visit fees in relation to such examinations.

Questions?

Braden Kalichuk
bkalichuk@docsmb.org
(204) 985-5848

 

 

Updated: November 2016