Rule of Application 1, Call or Examination, is an important and often overlooked rule in the Physician’s Manual. This rule permits a physician to claim a visit fee where a patient’s situation requires a separate visit by a third party. 

Submit a claim upon meeting the following criteria:

1. Exceptional circumstances* exist; and
2. The third-party visit must be arranged by formal appointment and last a minimum of 15 minutes.

*Exceptions circumstances are not defined If the third party is not a family member, nor another health professional, you should consider whether the meeting will be expected to have a positive outcome for your patient. Examples could be a patient’s neighbours, teacher, or faith leader (pastor, rabbi, imam) who may have useful information to share. You should always be cautious about sharing your patient’s personal health information.

Claiming an additional visit fee may be a good option. A third-party visit does not meet the criteria of either Tariff 8474 Case Management Conference or Tariff 8473 Patient Care Family Conference. Claims should be submitted by Special Report, with a brief explanation as to the necessity for the third party visit.

Billing Notes:

1. While this rule does not explicitly prescribe which particular visit fee should represent claims for third-party meetings, Doctors Manitoba recommends that you exercise discretion as to which is the most appropriate visit tariff to be claimed. In most cases, it is likely to be a regional or subsequent visit.
2. If you wish to bill under this rule, the patient’s chart must contain thorough documentation of the service provided.