Pre-Scheduled Surgical Services — Visit Fees
Doctors Manitoba recommends that if it is medically necessary to examine a patient prior to performing a surgical service on a “pre-scheduled basis” that you should:
- Submit a claim under the appropriate visit tariff, in addition to your claim for the surgical service; and
- 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.
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.
- There is no “hard and fast” rule when it is “medically necessary” to examine a patient on the same day as a pre-scheduled surgical service. Decide each case on its own merits.
- However, there is an understanding between Doctors Manitoba and Manitoba Health that, to qualify for a visit fee, the nature of the examination must be more extensive or significantly different than a standard identification of the patient/surgical site.
Suppose you examine the patient on the same date as a pre-scheduled surgical service. In that case, the patient chart should include 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.