Supervision and administration - Fee Code 54494

(a) When fee code 54494 is billed, the claim date must be the last date of each completed week or supervision where a week begins 12:00 a.m. Monday and ends 11:59 p.m. Sunday. 

(b) If the billing physician provides in person dialysis services to the patient at the satellite site, the amount that can be claimed for fee code 54494 that week must be reduced by 50%.

Teledialysis Assessment with Patient, Once Per Week, Per Patient - Fee Code 54496

(a) “Teledialysis Assessment” is a medical service provided to a chronic haemodialysis patient present at a DHCS approved satellite haemodialysis site in Newfoundland and Labrador, through a direct interactive video link with a receiving physician at an approved telemedicine site in Newfoundland and Labrador. The patient must be present at the same time as the physician. The physician may initiate the service. This code is payable to a maximum of one physician per patient, per week. 

(b) The record of a teledialysis assessment must include the findings through history, observations from visual inspection (if any), and plan of investigation or treatment. It is understood that the diagnosis is chronic renal failure and that the reason for the visit is review of the dialysis patient’s status. 

(c) When fee code 54496 is billed, the date of service must be the actual date the physician-patient teledialysis encounter took place. For the purpose of billing this code, a week begins 12:00 a.m. Monday and ends 11:59 p.m. Sunday. 

Electrophysiologic Pacing, Mapping and Ablation

Fee Code 54333 is billable under the following conditions: The advanced mapping system is used in hospital for mapping the following arrhythmias:

Atrial arrhythmia 

Atrial fibrillation 

Atypical atrial flutter 

Post-surgical atrial flutter 

Atrial tachycardia 

Redo typical atrial flutter 

Redo reentrant tachycardia (accessory pathways, AV nodal reentry)

Provincial Perinatal High Risk Unit

The fees listed are only applicable to patients who are admitted to the unit and have been designated as high risk and are payable only to the physician in charge of the patient. The Concurrent Care fee for ICU, fee code 51790, may also be claimed by a second obstetrical specialist sharing in the on-going care of the patient.

DIAGNOSTIC AND THERAPEUTIC SERVICES 

This section of the Schedule identifies the amounts payable for miscellaneous professional services. Designation of site for claiming the service is based on where the procedure is performed rather than where it is interpreted.

f a procedure is performed in a hospital and is listed both in this section and the In-Hospital Diagnostic Section, it must be claimed using the fee code listed in the In-Hospital Diagnostic Section.

When a procedure(s) is the sole reason for a visit, no consultation or visit fees should be charged. However, fee code 54000 may be claimed, unless stated otherwise.

Billing rules for immunization of beneficiaries who belong to target populations designated by the DHCS are as follows:

(a) visit for assessment plus single immunization - claim visit fee only,

(b) visit for assessment plus two immunizations - claim visit fee plus one unit of fee code 54656, 

(c) visit for immunization against influenza and pneumococcal disease - claim one unit of 54650 and one unit of 54656,

(d) visit for immunization against influenza only - claim one unit of fee code 54650, and 

(e) visit for immunization against pneumococcal disease only - claim one unit each of fee codes 54000 and 54658.  

ICU and CCU Care

These fees apply to the services of being in constant or periodic attendance during a one day period, to provide all aspects of care to patients in Intensive or Coronary Care Units designated by the DHCS. There are four levels of care depending upon the procedures performed: 

(a) Comprehensive Care - This is the service rendered by a physician who provides complete care (both Critical Care and Ventilatory Support) to Critical Care Area patients. Comprehensive Care fees are not payable for services rendered to stabilized patients in ICUs or patients admitted for ECG monitoring or observation alone. 

(b) Critical Care - This is the service rendered by a physician who provides all aspects of care to a Critical Care Area patient except Ventilatory Support. Critical Care fees are not payable for services rendered to stabilized patients in ICUs or patients admitted for ECG monitoring or observation alone. 

(c) Observatory Care - This is the service rendered to stable ICU or CCU patients without invasive monitoring and without assisted ventilation. 

(d) Ventilatory Support - This is the service provided by a physician other than the one claiming Critical Care. It includes management of the intubated airway, tracheal toilet by suction catheter with or without instillation, and supervision of mechanical ventilation of the critically ill patient. 

These are team fees which apply to physicians providing complete daily care and should be claimed by the physician in charge of the patient. The daily fee includes payment for the initial consultation, subsequent assessments, and the ongoing monitoring of the patient’s condition, including the following procedures as required:

(a) insertion of IVs, intraosseous, arterial and CVP lines,

(b) use of pressure infusion sets, 

(c) endotracheal intubation and tracheobronchial toilet, 

(d) insertion and maintenance of urinary catheters and nasogastric tubes, 

Neonatal Intensive Care Unit (NICU)

These fees apply to the services of being in constant or periodic attendance during a one day period, to provide all aspects of care to patients in Neonatal Intensive Care Units designated by the DHCS. There are three levels of care depending upon the procedures performed.

These are team fees which apply to Neonatologists/Pediatricians/Anaesthesiologists providing complete daily care and should be claimed by the physician in charge of the patient. The daily fee includes the initial consultation, subsequent assessments, and the ongoing monitoring of the patient’s condition, including the following procedures as required:

(a) insertion of IVs, arterial and CVP lines, 

(b) use of pressure infusion sets, 

(c) endotracheal intubation and tracheobronchial toilet, 

(d) insertion and maintenance of urinary catheters and nasogastric tubes,

(e) securing and interpreting the results of arterial blood gas samples, and 

(f) the use of artificial ventilation.

These fees may be claimed in the post-operative period for patients receiving either Level A or B care. Level C care cannot be claimed for post-operative infants.

Physicians not part of the daily care team, whose additional expertise is required, may bill for each item of service performed, including Concurrent Care (fee code 51790).

When a patient’s care is transferred to a higher or lower level, the second day rate for that level applies. However, in any one period of NICU care, the first day rate for the highest level is payable for the date the patient transferred to that level. Only one first day rate is payable per NICU period.

Supportive Care

Supportive Care is the (non-surgical) care rendered in-hospital by the referring family physician, who is not actively treating the case (e.g. writing orders), to a patient under the care of another physician at the desire of the patient or family, for purposes of liaison or reassurance. Supportive Care may be claimed by family physicians only, using either Visit Code 371 or 372.

Visit for Procedure Only 

When the sole reason for a visit is the performance of a procedure listed in the Diagnostic and Therapeutic Section of the Schedule, visit codes should not be claimed. This service should be claimed by billing the appropriate procedural code and fee code 54000, unless otherwise specified.

Transfer of Care Surcharge

Fee code 160 may only be claimed by Psychiatrists who provide office-based care. It is payable for patients who are discharged from the psychiatrist’s practice to their family physician with a written treatment plan for the ongoing management of the patient’s mental health. The written treatment plan fulfills the documentation requirement for this service. A minimum of six separate follow up visits must occur before code 160 may be billed

The transfer of care code is intended to assist in the safe transition of appropriate patients, whose medical needs can be managed within primary care, from the psychiatrist to the primary care physician. The billing psychiatrist must meet the established visit requirements for this fee code and must provide a transition of care treatment plan to the family physician or designate that will provide guidance on biopsycho-social recommendations for the patient.

Routine Post-Operative Care by General Practitioners

Fee codes 118 and 418 must be claimed by General Practitioners who provide routine postoperative care to patients during the 42-day post-operative period. 

Specific Assessment

This shall consist of a full history of the presenting complaint, enquiry concerning, and detailed examination of the affected part, region or system as needed to make a diagnosis, exclude disease and/or assess function and advice to the patient. 

Not more than one major examination (Consultation, General Assessment, or Specific Assessment) per patient per physician may be claimed within a 90-day period regardless of diagnosis and referring source, except in cases of true emergency. Such claims must be submitted IC clarifying the nature of the emergency.

Specific Reassessment 

This shall consist of a full relevant history and examination of one or more systems of a patient not requiring a comprehensive evaluation of the patient as a whole.

Specific Reassessments apply in the ongoing management and assessment of disease and for following the progress of treatment.

The second and subsequent Specific Assessments on a patient within each 90 days should be claimed as Specific Reassessments.

Follow-up visits for monitoring the use of birth control pills qualify as Specific Reassessments, with or without fee code 54614, depending on the nature of the examination performed.

A visit for a requested Pap Smear and/or breast examination, without other significant medical complaints or illness, qualifies as a Specific Reassessment, with or without fee code 54614, depending upon the nature of the examination performed.

Pre-Dental General Assessment

This service shall consist of examination and documentation as is required for patients undergoing a general anaesthetic for surgical dental procedures only

General Practitioners may also bill this code for examination and documentation as is required for: 

i) children and adolescents undergoing diagnostic imaging studies under conscious sedation and: 

ii) patients undergoing a general anaesthetic for ECT.  

Psychiatric Care 

This service is any form of assessment and treatment by a Psychiatrist for mental illness, behavioural maladaption and/or other problems that are assumed to be of an emotional nature, in which there is consideration of, and alteration of the patient’s biological and psychosocial functioning.

Charges for hospital visits, home or office fees do not apply on a day when ECT or Psychiatric Care is charged, (same diagnosis, same physician).

Psychiatric Care is not payable on the same day as ECT.

Rules for the Claiming of Psychiatric Care  

 The minimum time period for Psychiatric Care (to be claimed as such) is 15 minutes. Claims for one or more units of Psychiatric Care should be made reflecting the following requirements of actual documented time spent with the patient.

Individual 

1 unit – 15 to 44 minutes 

2 units – 45 to 74 minutes 

3 units – 75 to 104 minutes

4 units – 105 to 134 minutes

5 units – 135 to 164 minutes, and so on

Psychiatric Day Care

This service may be claimed by Psychiatrists for visits to patients who are seen in a Psychiatry Day Care setting. It is not a per diem rate and may only be billed for a patient with whom an actual exchange took place during that visit.

Psychotherapy

For purposes of being an MCP-insured service, psychotherapy is defined as the treatment of mental illness, behavioural maladaptions, and/or other problems that are of an emotional nature, in which a physician deliberately establishes a professional relationship with a patient for the purpose of removing, modifying, or retarding existing symptoms, or attenuating or reversing disturbed patterns of behaviour, and/or promoting positive personality growth and development.

Psychotherapy may only be claimed when the physician purposefully undertakes to treat the patient’s emotional problem and that undertaking must be reflected in both the patient’s record and the diagnostic code used on the claim. The patient’s record must also include a note of the actual time spent as “psychotherapy” during that visit.

Counselling of a patient with a complex non-psychiatric illness is included in the visit fee and should not be claimed as psychotherapy. Marital and family counseling may be claimed as psychotherapy. 

Charges for hospital visits, home or office fees do not apply on a day when ECT or individual psychotherapy is charged, (same diagnosis, same physician).

Psychotherapy is not payable on the same day as ECT.