Overview
SOMB code 03.07A is paid for a minor in-office consultation performed at the request of another physician. It requires a referral source, a consultation-level assessment, and a written or electronic consult report back to the referring physician. Use 03.07A when the problem is focused and does not require the comprehensive workup that 03.08A demands.
Billing Requirements
- Written or electronic referral from another physician
- In-office assessment of the referred problem
- Consult report sent back to the referring physician
Common Audit Traps
⚠️ Alberta Health auditors specifically look for these mistakes when reviewing 03.07A claims:
- Billing 03.07A without a documented referral from another physician
- Using 03.07A for encounters that never generated a consult report
- Billing 03.07A when the work actually met the higher 03.08A requirements, or vice versa
Clinical Example
Another family physician refers a patient for an opinion on a focused dermatologic concern. In-office assessment performed, consult letter sent back. Bill 03.07A.
Documentation Tips (Audit-Proof)
- Store or reference the incoming referral in the chart
- Keep a copy of the consult report sent back to the referring physician
- Document the specific clinical question being answered
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Related SOMB Codes
Comprehensive Consultation — In Office
Comprehensive in-office consultation performed at the request of another physician. Requires a complete history, complete physical examination, and a written consult report.
Read GuideLimited Assessment — In Office
Limited assessment of a patient's condition requiring a history related to the presenting problems, a directed examination, and advice. The default GP office visit code.
Read GuideComprehensive Assessment — In Office
Comprehensive in-office assessment requiring a complete history and a complete physical examination. Use only when documentation actually supports a full workup.
Read Guide