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.

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.