Suggested Fee Guide for Small Animal Procedures

Transcription

1 The Canadian Veterinary Medical Association Suggested Fee Guide for Small Animal Procedures 2017 British Columbia IN PARTNERSHIP WITH

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3 TABLE OF CONTENTS PREAMBLE i SAMPLE INVOICES iii EXAMINATIONS 1 EXAM ROOM PROCEDURES 1 CONSULTATIONS 1 OPHTHALMIC PROCEDURES 1 RADIOGRAPHS 2 ELECTROCARDIOGRAPHY 2 FIBRE OPTIC TECHNIQUES 2 ULTRASOUND 2 IN-HOUSE LABORATORY 3 LABORATORY REFERRAL 3 VACCINATIONS 4 ANAESTHESIA AND SEDATION 6 ELECTIVE SURGERY 7 THERIOGENOLOGY 8 ORTHOPAEDIC SURGERY 9 OPHTHALMIC SURGERY 11 OTOLARYNGOLOGICAL SURGERY 12 GASTROINTESTINAL SURGERY 13 GENERAL SURGERY 14 DENTISTRY 15 PROFESSIONAL SERVICES 16 BOARDING AND HOSPITALIZATION 18 FLUID THERAPY 19

4 PREAMBLE 1. The fees in this publication were prepared for the CVMA-Society of British Columbia Veterinarians Chapter in partnership with the Canadian Veterinary Medical Association to provide, to whom it may concern, a list of fees considered fair and just. These fees are only to serve as a guide. They are not intended to be binding on any party. No person is under any obligation to follow the fees published herein. If any person should choose not to follow these fees, he/she will not suffer in his/her relations with the CVMA-Society of British Columbia Veterinarians chapter members, or affiliates of the CVMA-Society of British Columbia Veterinarians Chapter. Members of the profession must remember that conspiring to fix fees is a serious matter which could result in a breach of the Federal Competition Act. Simply stated, British Columbia veterinarians should not cooperate or agree amongst themselves to use the Fee Guide to influence upwards fees for veterinary services. The use of the Fee Guide by any veterinarian is a matter of individual choice. 2. The following fees are determined to be reasonable for a doctor with average professional skill, judgment and dexterity rendering services under normal operating conditions. However, even under circumstances in which these conditions are fulfilled, no practitioner is obliged to charge for services as they are listed in this guide. 3. Fees in the 2017 Fee Guide are formulated from: the British Columbia survey of hospital owners; the procedure frequency study from British Columbia economic surveys; the time study undertaken in British Columbia economic surveys; the state of the economy in 2016 and forecasts for Fees are derived using: costs of overhead, non-veterinary staff salaries and benefits, rent, utilities, supplies, etc. (adjusted for inflation); time to perform the procedure as established in the economic survey; relative value of the procedure, relating to complexity, skill, responsibility and risk involved (established from the economic survey); and value of the veterinarian s time, measured by comparing salaries of individuals working in comparable professions. 4. It is considered fair and just that an altered fee may be rendered where: the case presents unusual complications; the case demands exceptional skill or time; the case demands immediate attention at the sacrifice of regular practice routine; chronic or prolonged attention is provided at the convenience of the doctor; the case may provide financial hardship to the client. i

5 5. I.C. or Independent Consideration is utilized where the method used or amount of necessary service has a large variance. 6. The four-digit code system is designed for reference to type of animal, type of service and procedure. This method was designed to track revenue by species. In the animal specific sections, the first digit designates the type of animal and the remaining three digits designate the procedure. Specific ranges are given to each type of service. The following table illustrates how the Fee Guide has been divided for different species. CANINE FELINE Examinations Vaccinations Anaesthesia and Sedation Surgery Dentistry Professional Services Hospitalization & Fluid Therapy The coding in the Birds and Exotics section of the Guide does not correspond to the Canine and Feline sections. It is presented alphabetically by section. 8. Unless otherwise noted, fees are only for the procedure identified and do not include anaesthesia, charges for extra material, or special instrumentation. 9. The Fee Guide may be used to assist the practitioner when determining a professional fee. The following steps are recommended for a successful client / veterinarian relationship. a) Perform a thorough examination of the patient, explaining your findings as you proceed. b) Describe the treatment plan and prognosis in a manner which the client can fully understand. Assure yourself that the client has understood the presentation and encourage questions. c) Present your estimate of fees for treatment and obtain the owner s consent before beginning treatment. In all cases, your fee should be based on your skill, judgment and experience. Copyright 2017, Canadian Veterinary Medical Association and CVMA-Society of British Columbia Veterinarians Chapter. All rights reserved. No part of this work covered by the publisher s copyright may be reproduced or copied in any form or by any means (graphic, electronic or mechanical, including photocopying, recording, recording taping, or information and retrieval systems) without the written permission of the publisher. ii

6 Sample Invoices Scenario Feline Abscess Flushed abscess and sutured in drain Procedure Description Unit Units Price Code Cost 2000 examination / consultation $ $ blood collection preanaesthetic blood profile with CBC FIV / FeLV ELISA test hospitalization - part day (boarding + monitoring) anaesthetic induction plus 10 minutes of maintenance anaesthesia fee (includes monitoring and agent - per 10 min) IV fluids during anaesthetic injection-intramuscular/subcutaneous (first) preoperative pain medication 2590 surgical fee per 10 minutes dispensing fee (per prescription) pain management medication for home use IC *plus medications with mark-up Total* $ iii

7 Scenario Canine Dental Prophy with Carnassial Extraction that takes 30 minutes to remove via sectioning. 40 Kg. in weight. Antibiotic and pain control injections are given. Procedure Description Unit Units Price Code Cost 1805 hospitalization - part day (boarding + monitoring) $ $ blood collection preanaesthetic blood profile with CBC anaesthetic induction plus 10 minutes of maintenance IV fluids during anaesthetic anaesthesia fee (includes monitoring and agent - per 10 min) dental examination dental prophylaxis / polish - technician performed (grade iii/iv) dental x-ray dental x-ray (additional) fluoride gel application dental nerve block injection-intramuscular/subcutaneous (first) preoperative pain medication 1356 anaesthesia fee (monitoring & agent - per 10 min) - for extraction extractions per 10 minutes injection-intramuscular/subcutaneous (additional) postoperative pain medication 1732 dispensing fee (per prescription) *plus medications with mark-up Total* $1, iv

8 Scenario Feline Dental Prophy (routine) Procedure Description Unit Units Price Code Cost 2805 hospitalization - part day (boarding + monitoring) $ $ blood collection preanaesthetic blood profile with CBC anaesthetic induction plus 10 minutes of maintenance anaesthesia fee (includes monitoring and agent - per 10 min) IV fluids during anaesthetic dental examination routine dental / prophylaxis / polish (grade i/ii) fluoride gel application injection-intramuscular/subcutaneous (first) post-operative pain medication 2732 dispensing fee (per prescription) *plus medications with mark-up Total* $ v

9 Scenario Feline Spay (Immature) Procedure Description Unit Units Price Code Cost 2051 blood collection $ $31.10 preanaesthetic blood profile with CBC ovariohysterectomy - with IV fluids dispensing fee (per prescription) pain management medication for home use IC elizabethan collar IC Total $ If cat is obese, in heat, and mature, additional fees would be appropriate in heat IC 2416 obese IC 2418 mature IC vi

10 Scenario Canine (Labrador Retriever) Fractured Mid Shaft Femur - Plated 20 Kg. in weight. Procedure Description Unit Units Price Code Cost 1000 examination / consultation $ $ hospitalization - 24 hours (boarding + professional care) blood collection preanaesthetic blood profile with CBC radiograph - set up and initial 2 views radiograph (additional view) - chest to R/O trauma epidural anaesthetic induction plus 10 minutes of maintenance anaesthesia fee (includes monitoring and agent - per 10 min) injection-intramuscular/subcutaneous (first) pre-operative pain medication 1594 surgical pack fee - standard - 2 gown surgical pack fee - special for use and cleaning of orthopaedic equipment 1591 materials eight hole plate and screws 1466 orthopaedic surgical fee per 10 minutes surgical assistant fee per 10 minutes second person to assist surgery for 20 minutes 1859 IV set up and maintenance - base fee IV (daily maintenance fee - additional days) injection-intravenous (into IV line) antibiotics and pain management 1101 radiograph (additional view) - post-op fracture blood collection PCV + total protein oral medication (antibiotics used in hospital) dispensing fee (per prescription) Total $4, vii

11 Scenario Large adolescent dog with laceration. Local anaesthesia administered and two technicians required for restraint. Procedure takes 10 minutes. Dog is not admitted for hospitalization. Procedure Description Unit Units Price Code Cost 1000 examination $ $ anaesthetic - local technician time per 10 minutes prep room fee (cleaning & supplies used in preparation of procedure) laceration (minor) dispensing fee (per prescription) Total* $ *plus medications with mark-up viii

12 Scenario After discussion with client during the annual examination, Dr A decides to use an annual distemper combination along with rabies and Bordetella vaccines in separate syringes. Procedure Description Unit Units Price Code Cost 1000 examination $ $ annual vaccination (any distemper combination) Rabies vaccine with other vaccination Bordetella / intra nasal with other vaccination Total $ The SBCV Economics Committee highly recommends that veterinarians start emphasizing the importance of the annual examination. Separating out the cost of the vaccines and the cost of the exam is one method of doing this. If future research allows us to decrease the frequency of booster vaccines, it will be important for our clients to understand that yearly examinations will still be needed. ix

13 Scenario After discussion with client during the annual examination, Dr. AA decides to vaccinate for distemper in year 1, Parvo in year 2 and rabies in year 3, then continue the three year rotation. Using the new vaccination protocol and the Fee Guide the fee for year 1, 2 and 3 of the rotation would be: Procedure Year 1 Unit Units Price Code Cost 1000 examination $ $ annual vaccination (any combination) - Distemper Total $ Year examination $ $ annual vaccination (any combination) - Parvo Total $ Year examination $ $ Rabies vaccination alone with examination Total $ The SBCV Economics Committee highly recommends that veterinarians start emphasizing the importance of the annual examination. Separating out the cost of the vaccines and the cost of the exam is one method of doing this. If future research allows us to decrease the frequency of booster vaccines, it will be important for our clients to understand that yearly examinations will still be needed. x

14 Scenario After discussion with client during the annual examination, Dr. X recommends distemper combination plus rabies. Client declines distemper and requests rabies only. Using the new vaccination protocol and the Fee Guide the fee would be: Procedure Description Unit Units Price Code Cost 1000 examination $ $ Rabies vaccine Total $ The SBCV Economics Committee highly recommends that veterinarians start emphasizing the importance of the annual examination. Separating out the cost of the vaccines and the cost of the exam is one method of doing this. If future research allows us to decrease the frequency of booster vaccines, it will be important for our clients to understand that yearly examinations will still be needed. xi

15 Scenario After discussion with client during the annual examination, Dr. C recommends distemper combination with an additional Bordetella vaccine in a separate syringe plus additional Lyme vaccination in a separate syringe. Using the Fee Guide the fee would be: Procedure Description Unit Units Price Code Cost 1307 annual examination $ $ annual vaccination (distemper) Bordetella / intra nasal with other vaccination Lyme vaccine with other vaccination Total $ The SBCV Economics Committee highly recommends that veterinarians start emphasizing the importance of the annual examination. Separating out the cost of the vaccines and the cost of the exam is one method of doing this. If future research allows us to decrease the frequency of booster vaccines, it will be important for our clients to understand that yearly examinations will still be needed. xii

16 Sample Bundled Services Procedure Description Unit Units Price Code Cost Bundled Services for healthy two year old dog requiring preventative care 1307 annual examination and vaccination $ $ blood collection early detection panel (up to 6 tests with partial CBC) faecal floatation cystocentesis urinalysis, complete nail trim Total $ Monthly Payment for One Year * $35.39 Bundled Services for healthy two year old cat requiring preventative care & dental cleaning 2312 annual examination and vaccination $ $ blool collection comprehensive diagnostic panel (up to 22 tests, CBC, T4) faecal floatation urinalysis, complete nail trim dental cleaning (see sample invoice above) Total $ Monthly Payment for One Year * $82.37 Bundled Service for healthy puppy requiring preventative care and elective surgery Visit complete examination and vaccination $ $ faecal floatation deworming Visit complete examination and vaccination faecal floatation Visit complete examination and vaccination Visit orchidectomy (medium kg) - with IV fluids preaneasthetic panel (up to 6 tests with partial CBC) Total $ Monthly Payment for One Year * $70.49 *Additional features: complimentary recheck exams for a year (optional). xiii

17 EXAMINATIONS AND OFFICE PROCEDURES Canine Feline Examinations examination / consultation each recheck / re-evaluation each emergency after hours surcharge (not including examination) surcharge examination / consultation (extended) each behavioural consultation half hour house call (does not include exam) fee house call (mileage) 3.90 km kennel or cattery call - professional time hour in hospital examination (by veterinarian) each Consultations prescription writing fee fee consult with other professional / specialist each consultation - telephone (client) each copy files I.C write referral letter fee telephone fee, long distance I.C telephone refills at outside pharmacy fee fee to consult with outside pharmacy, review and update medical records Exam Room Procedures Brushing, shaving, cleaning - See Hospital Unit on Page anal glands per patient each blood collection each blood pressure (during examination) fee blood pressure (ongoing monitoring) fee ear clean (during examination) fee nail trim each electronic microchip implant (does not include implant) each dispensing fee (per prescription) each injection-outpatient each Ophthalmic Procedures fluorescein eye stain (per patient) each Schirmer tear test (per patient) each tonometry (per patient) each anaesthetic - topical ophthalmic each British Columbia 2017 P 1 I.C. - Independent Consideration

18 DIAGNOSTIC IMAGING All fees for RADIOGRAPHS include a professional interpretation fee. Radiographs Fees for Radiographs should include: radiograph - set up fee (code ) plus fee for each view (code , ). Fees for plates vary only according to the number of views (not by size). Canine Feline radiograph - set-up and initial 2 views - includes interpretation each radiograph (additional view) - includes interpretation each barium swallow x-ray barium enema x-ray cystogram - positive contrast x-ray intravenous pyelogram x-ray myelogram x-ray pneumocystogram x-ray urethrogram x-ray 1119 OFA evaluation / certification package fee PennHIP evaluation / certification I.C. Note: Evaluation / certification fee includes sedation, radiograph, part day hospitalization, correspondence fee, printing / postage fee and certification charges radiology referral (not including radiograph) I.C. Note: radiology referral includes referral letter, telephone consultation, radiologist's fee, and add 100% for professional interpretation. Electrocardiography ECG Cardiopet Cardiopet ECG (in house) each Fibre Optic Techniques endoscopy minutes Ultrasound Note: Ultrasound and fibre optic techniques are generally done either by hospital personnel with hospital equipment, or by an ultrasound consultant. The fees for codes are for the ultrasounds by hospital personnel with hospital equipment. The fee is for the ultrasound or fibre optic procedure only (anaesthesia, sedation, and hospitalization extra) ultrasound - cardiac with Doppler each ultrasound - abdomen each ultrasound - bladder each ultrasound - guided biopsy - materials and histology extra each ultrasound - pregnancy each ultrasound - consultant I.C ultrasound - centesis add on Note: "Ultrasound-consultant" fees should include consultant's fees, plus appropriate hospital charges (anaesthesia, sedation, technician, hospitalization). British Columbia 2017 P 2 I.C. - Independent Consideration

19 IN-HOUSE LABORATORY These fees do not include blood collection fee (code ) unless noted. * Includes Collection Canine Feline blood collection each Hematology blood smear / differential each complete blood count each preanaesthetic blood profile with CBC I.C haemoglobin each PCV each PCV + total protein each white blood cell count each Cytology each Sample Collection - Cytology Fee in Addition abdominocentesis each arthrocentesis (joint tap) - add pack fee (Code 1592) minutes cerebrospinal fluid tap each cystocentesis each fine needle aspirate (does not include lab) each impression smear each thoracocentesis each transtracheal wash each Sample Collection and Evaluation (includes cytology) *ear swab each *faecal smear each *semen collection and evaluation each *vaginal swab each Bacteriology *culture and sensitivity each *Gram stain each Parasitology *dermatophyte assay each *faecal floatation (ova & parasite) each 1252 *heartworm test each *skin smear / scraping each *Wood's lamp each Urinalysis (add cystocentesis if applicable) urinalysis, complete each urine test strip each Virology 2272 FIV / FeLV test each Serology Fee for in hospital chemistries should equal the fee charged if sent to an outside lab. LABORATORY REFERRAL For Laboratory Referral work done outside the clinic, include collection fees, the laboratory fee, and add 100% for professional interpretation. British Columbia 2017 P 3 I.C. - Independent Consideration

20 VACCINATIONS Canine Vaccinations (with exam) Vaccination fees include a complete examination unless noted. Vaccine prices were derived by adding the fee attributed to each vaccine to the fee for the examination. Examination Annual Vaccination (any distemper combination) Recheck / re-evaluation All other vaccines Bordetella / intra nasal Lyme vaccine Giardia Rabies Canine Examples of Charges 1307 annual vaccination each 1308 annual vaccination with rabies each 1310 other vaccinations - in combination - add for each vaccination each 1300 Bordetella / intra nasal (with examination) each 1301 Bordetella / intra nasal with other vaccination add 1302 RV (alone with exam) each 1303 CPV (20 week booster with examination) each 1318 Lyme vaccine (with exam) each We highly recommend that veterinarians start emphasizing the importance of the annual examination. If future research allows us to decrease the frequency of booster vaccines, it will be important for our clients to understand that yearly examinations will still be needed. British Columbia 2017 P 4 I.C. - Independent Consideration

21 VACCINATIONS Feline Vaccinations (with exam) Vaccination fees include a complete examination unless noted. Vaccine prices were derived by adding the fee attributed to each vaccine to the fee for the examination. Examination Annual Vaccination (any distemper combination) Recheck / re-evaluation Annual Vaccination without FeLV Annual Vaccination with FeLV FeLV FIV Vaccine Feline Examples of Charges 2313 annual vaccination with FeLV each 2315 annual vaccination with FeLV and rabies each 2312 annual vaccination without FeLV each 2316 annual vaccination without FeLV, with rabies each 2310 other vaccinations - in combination - add for each vaccination add 2302 RV (alone with exam) each 2304 FeLV (alone with exam) each We highly recommend that veterinarians start emphasizing the importance of the annual examination. If future research allows us to decrease the frequency of booster vaccines, it will be important for our clients to understand that yearly examinations will still be needed. British Columbia 2017 P 5 I.C. - Independent Consideration

22 ANAESTHESIA AND SEDATION Canine Feline Induction Induction plus 10 minutes of maintenance each Note: Anaesthetic induction fee includes: - preanaesthetic exam (TPR) - cephalic catheter - patient premedication - induction of sufficient plane of anaesthesia to allow intubation and maintenance Anaesthetic Maintenance anaesthesia fee (monitoring plus cost of anaesthetic agent per 10 min) minutes Propofol (add monitoring) 1.80 per ml medetomidine anaesthetic - including reversal each Anaesthetic anaesthetic - local (add technical assistant time as appropriate) each anaesthetic - topical ophthalmic each epidural each sedation - intramuscular each sedation - intravenous each Sedations in these categories are not to the level that would permit intubation. Anaesthetic IV Fluids Base Fee - includes base fee drip set bag of fluids technician time per 10 minutes minutes British Columbia 2017 P 6 I.C. - Independent Consideration

23 Canine Feline ELECTIVE SURGERY Fees for orchidectomies, ovariohysterectomies and declaw procedures include surgeon and technician time, operating room charge, surgical pack, surgical materials, anaesthesia and hospitalization, and apply to young animals only (under 1 yr. of age). Note: For retained testicles or mature spay, add fee appropriate to extra time necessary. Inter-operative pain control is included. Does not include post-operative pain control medications dispensed after surgery. Canine Orchidectomies / Ovariohysterectomies 1400 orchidectomy (small < 10 kg) - with IV fluids each 1401 orchidectomy (medium kg) - with IV fluids each 1402 orchidectomy (large > 20 kg) - with IV fluids each 1403 orchidectomy / inguinal cryptorchid - with IV fluids each 1404 orchidectomy / intra-abdominal cryptorchid - with IV fluids each 1405 ovariohysterectomy (small < 10 kg) - with IV fluids each 1406 ovariohysterectomy (medium kg) - with IV fluids each 1407 ovariohysterectomy (large kg) - with IV fluids each 1408 ovariohysterectomy (x-large > 40 kg) - with IV fluids each 1409 dew claw removal - mature dog minutes The following are in addition to the above: 1415 in heat add 1416 obese minutes 1417 pregnant minutes 1419 hernia - umbilical minutes Neonatal Surgery 1420 dew claws (per puppy) each Feline Orchidectomies / Ovariohysterectomies 2400 orchidectomy - with IV fluids each 2403 orchidectomy / inguinal cryptorchid - with IV fluids each 2404 orchidectomy / intra-abdominal cryptorchid - with IV fluids each 2405 ovariohysterectomy - with IV fluids each 2406 mature ovariohysterectomy - with IV fluids each The following are in addition to the above: 2415 in heat add 2416 obese minutes 2417 pregnant minutes 2418 mature minutes 2419 hernia - umbilical minutes Anaesthetic IV Fluids for Elective Surgery Base Fee - includes base fee drip set bag of fluids British Columbia 2017 P 7 I.C. - Independent Consideration

24 Theriogenology Theriogenology care should be billed by procedure or time to include the following items that are appropriate: Hospitalization Surgical time calculated in 10 minute units Surgical assistant time (if required for surgery) calculated in 10 minute units Technician time calculated in 10 minute units Surgical packs and gowns Medications Medication administration fees Suture materials Anaesthetics * Sx Time represents the average surgical time in minutes Fees listed below are for surgical time component only Canine Feline Sx Time * technician time per 10 minutes minutes surgical fee per 10 minutes minutes surgical assistant per 10 minutes minutes Caesarean section (1 hour surgery) each prolapsed vagina minutes pyometra (1 hour surgery) each whelping or queening assistance minutes materials I.C. fee surgical pack fee - standard - 1 gown each surgical pack fee - standard - 2 gown each surgical pack fee - special I.C. each British Columbia 2017 P 8 I.C. - Independent Consideration

25 Orthopaedic Surgery Surgery should be billed by procedure or time to include the following items: Hospitalization Anaesthetic induction Anaesthetic maintenance Pain medication Surgical packs and gowns Special instrument (use if appropriate) Suture materials Procedure fee or surgical time calculated in 10 minute units Surgical assistant time (if required for surgery) calculated in 10 minute units Intravenous fluids Surgical hardware X-rays Medication in hospital Medications dispensed Lab work if appropriate See sample invoices * Sx Time represents the average surgical time in minutes Fees listed below are for surgical time component only Canine Feline Sx Time * orthopaedic surgical fee per 10 minutes minutes surgical assistant per 10 minutes minutes amputation, digit each amputation, foreleg each amputation, hindleg each amputation, tail each bone grafting minutes cervical disc fenestration minutes coxofemoral luxation - closed reduction each cruciate ligament repair (small) each cruciate ligament repair (large) each elbow joint exploratory minutes elbow luxation - closed reduction each excision arthroplasty each external fixation-cast each external fixation-m. Metasplint (small) each external fixation-m. Metasplint (medium) each external fixation-m. Metasplint (large) each external fixation-r.j. Splint (small) each external fixation-r.j. Splint (medium) each external fixation-r.j. Splint (large) each external fixation-thomas Splint (small) each external fixation-thomas Splint (medium) each external fixation-thomas Splint (large) each 21 British Columbia 2017 P 9 I.C. - Independent Consideration

26 Orthopaedic Surgery (continued) Surgery should be billed by procedure or time to include the following items: Hospitalization Anaesthetic induction Anaesthetic maintenance Pain medication Surgical packs and gowns Special instrument (use if appropriate) Suture materials Procedure fee or surgical time calculated in 10 minute units Surgical assistant time (if required for surgery) calculated in 10 minute units Intravenous fluids Surgical hardware X-rays Medication in hospital Medications dispensed Lab work if appropriate See sample invoices * Sx Time represents the average surgical time in minutes Fees listed below are for surgical time component only Canine Feline Sx Time * fracture - closed reduction each fracture repair (open) minutes intramedullary pinning (open) each intervertebral disc surgery minutes I.M. pin removal each joint exploratory - other minutes Kirschner apparatus application each luxation reduction each luxation reduction (open) minutes mandibular symphysis wiring each shoulder joint exploratory minutes shoulder joint OCD curettage minutes temporomandibular luxation - closed reduction each tibial crest transplant / patella stabilization each ununited anconeal process fixation minutes ununited anconeal process removal minutes materials I.C. fee surgical pack fee - standard - 1 gown each surgical pack fee - standard - 2 gown each surgical pack fee - special I.C. each British Columbia 2017 P 10 I.C. - Independent Consideration

27 Ophthalmic Surgery Surgery should be billed by procedure or time to include the following items: Hospitalization Anaesthetic induction Anaesthetic maintenance Pain medication Surgical packs and gowns Special instrument (use if appropriate) Suture materials Procedure fee or surgical time calculated in 10 minute units Surgical assistant time (if required for surgery) calculated in 10 minute units Intravenous fluids Medication in hospital Medications dispensed Lab work if appropriate * Sx Time represents the average surgical time in minutes Fees listed below are for surgical time component only Canine Feline Sx Time * surgical fee per 10 minutes minutes surgical assistant per 10 minutes minutes conjunctival flap (complete) each conjunctival flap (partial) minutes debride corneal ulcer each electroepilation - distichiasis minutes entropion correction - lower (1 eye) each entropion correction - upper and lower (1 eye) each eye enucleation each nasolacrimal duct flush each palpebral tumor / cyst (wedge resection) minutes parotid duct transplant minutes prolapsed 3rd eyelid gland (reduction and suture) each proptosed globe (reduction) minutes superficial keratectomy minutes corneal laceration - suture minutes tarsorrhaphy each third eyelid flap each materials I.C. fee surgical pack fee - standard - 1 gown each surgical pack fee - standard - 2 gown each surgical pack fee - special I.C. each British Columbia 2017 P 11 I.C. - Independent Consideration

28 Otolaryngological Surgery Surgery should be billed by procedure or time to include the following items: Hospitalization Anaesthetic induction Anaesthetic maintenance Pain medication Surgical packs and gowns Special instrument (use if appropriate) Suture materials Procedure fee or surgical time calculated in 10 minute units Surgical assistant time (if required for surgery) calculated in 10 minute units Intravenous fluids Medication in hospital Medications dispensed Lab work if appropriate * Sx Time represents the average surgical time in minutes Fees listed below are for surgical time component only Canine Feline Sx Time * surgical fee per 10 minutes minutes surgical assistant per 10 minutes minutes aural haematoma (drain / opening / suture) minutes bulla osteotomy (ventral) minutes bulla osteotomy (lateral) minutes ear canal ablation minutes lateral ear resection (unilateral) each lateral ear resection (bilateral) each everted laryngeal saccule resection each nasopharyngeal polyp resection minutes stenotic nares correction both soft palate resection each tonsillectomy each materials I.C. fee surgical pack fee - standard - 1 gown each surgical pack fee - standard - 2 gown each surgical pack fee - special I.C. each British Columbia 2017 P 12 I.C. - Independent Consideration

29 Gastrointestinal Surgery Surgery should be billed by procedure or time to include the following items: Hospitalization Anaesthetic induction Anaesthetic maintenance Pain medication Surgical packs and gowns Special instrument (use if appropriate) Suture materials Surgical time calculated in 10 minute units Surgical assistant time (if required for surgery) calculated in 10 minute units Intravenous fluids X-rays Medication in hospital Medications dispensed Lab work if appropriate Canine Feline Fees listed below are for surgical time component only surgical fee per 10 minutes minutes surgical assistant per 10 minutes minutes anal sacculectomy each cholecystotomy minutes enterotomy minutes esophageal surgery minutes gastrotomy minutes gastric torsion- gastrotomy / tie down minutes intestinal anastomosis minutes laparotomy minutes pyloromyotomy minutes recto-colonic pull through minutes total colonectomy minutes materials I.C. fee surgical pack fee - standard - 1 gown each surgical pack fee - standard - 2 gown each surgical pack fee - special I.C. each British Columbia 2017 P 13 I.C. - Independent Consideration

30 General Surgery Surgery should be billed by procedure or time to include the following items: Hospitalization Anaesthetic induction Anaesthetic maintenance Pain medication Surgical packs and gowns Special instrument (use if appropriate) Suture materials Procedure fee or surgical time calculated in 10 minute units Surgical assistant time (if required for surgery) calculated in 10 minute units Intravenous fluids X-rays Medication in hospital Medications dispensed Lab work if appropriate * Sx Time represents the average surgical time in minutes Fees listed below are for surgical time component only Canine Feline Sx Time * surgical fee per 10 minutes minutes surgical assistant per 10 minutes minutes biopsy - kidney (percutaneous) minutes biopsy - liver (percutaneous) minutes biopsy - lymph node minutes biopsy - skin minutes biopsy - mass minutes cystotomy each exploratory laparotomy minutes hernia - diaphragmatic minutes hernia - inguinal unilateral each hernia - perineal minutes hernia - inguinal bilateral each suture incision / laceration minutes laceration (major) minutes laceration (minor) minutes nephrectomy each urethrostomy - perineal each urethrotomy - prepubic each splenectomy each materials I.C. fee surgical pack fee - standard - 1 gown each surgical pack fee - standard - 2 gown each surgical pack fee - special I.C. each British Columbia 2017 P 14 I.C. - Independent Consideration

31 DENTISTRY Dentistry should be billed by time to include the following items: Hospitalization Anaesthetic induction Anaesthetic maintenance Pain medication Dental time calculated in 10 minute units Special instrument (use if appropriate) Suture materials Assistant time (if required for surgery) calculated in 10 minute units Intravenous fluids X-rays Medication in hospital Medications dispensed Lab work if appropriate See sample invoices Canine Feline Fees listed below are for procedural component only Prophylactic Services dental unit per 10 minutes of technician time minutes dental examination while anaesthetized each dental prophylaxis / polish-technician performed (grade I/II) each dental prophylaxis / polish-technician performed (grade III/IV) each fluoride gel application each fluoride varnish each Dental Radiology dental x-ray each dental x-ray (additional) each 2610 dental x-ray (full mouth feline) each Endodontics I.C. Dental Surgery root planing minutes dental surgery (eg. gingival flap) minutes Extractions extractions per 10 minutes minutes Dental Nerve Blocks dental nerve block per site materials I.C surgical pack fee - standard - 1 gown each surgical pack fee - special I.C. British Columbia 2017 P 15 I.C. - Independent Consideration

32 PROFESSIONAL SERVICES Note: for procedures not listed, fees can be calculated by using 10 minute units Technician time per 10 minute unit Surgical time per 10 minute unit Plus equipment or disposables Hospital Unit is applicable for time spent by doctor or technician performing non-surgical care: ear cleaning, wound cleaning / shaving in hospital or exam room. Canine Feline technician per 10 minutes minutes surgical fee per 10 minutes minutes abscess - Penrose drain / flush / suture each abdominal fluid drainage each abdominocentesis each anal glands expressed each anal glands expressed with infusion each arthrocentesis (joint tap) - add pack fee (code 1592) minutes artificial insemination each necropsy - histology extra each necropsy (referral) I.C. each Note: Necropsy referral includes: lab fees, professional time for submission, interpretation and consultation (20 minutes) bandaging (small) each bandaging (large) each blood collection each blood pressure (during examination) each blood pressure (ongoing monitoring) each burial I.C cast removal each catheterization - urinary (female) each 2719 catheterization - urinary (flush bladder / F.U.S.) minutes catheterization - urinary (male) each cerebrospinal fluid tap each clean wound minutes cystocentesis each deworm (oral - round / hookworm) I.C deworm (oral - tapeworm) I.C dispensing fee (per prescription) each Add cost of medications plus markup. Markup on medications is left to the discretion of the individual veterinarian ear flush / medicate each ear pluck / flush / medicate each electronic microchip implant (does not includes implant) each enema each additional enema (each) each fine needle aspirate (does not include lab) each lavage (gastric or other) each medicated bath each oxygen set up I.C oxygen (add intensive care fee) hour patient transportation I.C nail trim each British Columbia 2017 P 16 I.C. - Independent Consideration

33 PROFESSIONAL SERVICES (continued) Note: for procedures not listed, fees can be calculated by using 10 minute units Technician time per 10 minute unit Surgical time per 10 minute unit Plus equipment or disposables Technician time is applicable for time spent by doctor or technician performing non-surgical care: ear cleaning, wound cleaning / shaving in hospital or exam room. Canine Feline prep room fee (cleaning & supplies used in preparation of procedure) each prostate wash each quill removal minutes replace splint each stomach tube each tattooing (1st) each tattooing (additional litter mates) each thoracic air / fluid drainage minutes transtracheal wash each warm water thermal pad / day day Medication Administration Outpatient injection - outpatient (all injections) each Injections injection - intramuscular / subcutaneous (first) each injection - IM / SC (additional) each injection - intravenous each injection - intravenous (into IV line) each oral medication day Costly medications should be billed for in addition to the above injection fees. Euthanasia / Cremation cremation (up to 7.5 kg) I.C cremation ( kg) I.C cremation (23-44 kg) I.C cremation (> 44 kg) I.C private cremation (ashes returned) I.C euthanasia (elective) each euthanasia (with previous treatment) each care of remains each British Columbia 2017 P 17 I.C. - Independent Consideration

34 Boarding and Hospitalization For Non-Elective Procedures Canine Feline 2801 boarding - cage - cat hours 1802 boarding - cage - dog hours boarding - run hours Hospitalization includes boarding plus monitoring of a patient by a professional - technician or veterinarian. Note: In hospital examination by veterinarian is additional charge hospitalization - part day (boarding + monitoring) part day hospitalization - 24 hours (boarding + monitoring) each isolation [in addition to the hospitalization fee] part day intensive care surcharge (1/2 day) additional intensitive care surcharge (1 day) additional i.e. Parvo - case [replaces the professional care fee] * HOW TO CHARGE HOSPITALIZATION A cat admitted in the morning and sent home that evening would be charged: Code hospitalization part day If this cat was discharged the next morning, you would charge: Code hospitalization - 24 hrs* * not including professional time technician time per 10 minutes minutes In addition to boarding and the appropriate professional fee, there may be chargeable time for unusual care for which there is no specific code. Such care may include flushing abscesses, clipping hot spots, removing porcupine quills, etc. This service may be performed by a technician. The technician unit fee provides a mechanism of billing for such procedures based on a ten minute unit of time. British Columbia 2017 P 18 I.C. - Independent Consideration

35 FLUID THERAPY Canine Feline IV Set Up and Maintenance Base Fee - includes base fee I.V. catheterization (cephalic) drip set bag of fluids I.V. (daily maintenance fee - first day) Add On Procedures I.V. bolus add on butterfly catheter add on butterfly catheter (replace) I.C I.V. catheterization (cut down) I.C I.V. catheterization (jugular) add on I.V. catheterization (replace) add on Note: Catheterization includes the cost of the catheter. Administration Set / Fluids Buretrol administration set add on extension set add on I.V. infusion pump drip set add on use of fluid pump (one time charge) add on bag of fluids add on Subcutaneous Fluids subcutaneous fluids each Maintenance I.V. (daily maintenance fee - additional days) add on Blood Transfusion blood transfusion (does not include cross matching) each Note: Fees may be itemized or used as a one line fee. Anaesthetic IV Fluids Base Fee - includes base fee drip set bag of fluids British Columbia 2017 P 19 I.C. - Independent Consideration