Concurrent Care

This refers to the clinical situation where care by more than one physician is required for a hospital in-patient. Concurrent Care must be verifiable as having been requested by the attending physician. The documentation requirements for Concurrent Care are the minimum documentation requirements for visits as described in this Preamble.

Concurrent Care of a registered hospital in-patient is an assessment by a consultant following the consultant’s first major assessment. The attending physician continues to be responsible for ongoing care but requests Concurrent Care by the consultant. Concurrent Care in settings other than ICU, NICU or CCU must be billed using fee code 360.

Concurrent Care for a patient in an ICU, NICU or CCU must be billed using fee code 51790. Concurrent Care visits made on multiple days should be billed as multiple units of fee code 51790. The date the final visit was made should be used as the date of service for claiming purposes.

When a non-IOP surgical procedure is performed on an in-patient by a physician other than the attending physician, the fee payable includes post-operative care for 14 days in hospital. In this case, the patient is considered to have been transferred to the care of the operating physician and the attending physician may not continue to claim for daily care unless the need for such Concurrent Care can be verified. The claim must be billed as fee code 360

Detention

Detention may be charged in addition to a visit when the physician is required to spend extra time in continuous active bedside treatment of a seriously ill patient to the exclusion of all other work, except as noted below.

Detention is not payable for:

(a) usual preoperative or postoperative care by the operating surgeon, 

(b) the same physician in addition to fees for ICU, CCU and NICU care for the same day unless so specified elsewhere in this Payment Schedule, 

(c) procedural fee codes or in lieu of procedural fees, and 

(d) time spent waiting for x-rays, lab reports, the operating room, patient arrival or for patient transfer to another facility. 

Claims for detention must be billed IC and include information as to the nature of the patient’s condition requiring physician presence, actual time spent in continuous attendance and a brief description of the service(s) rendered.

 Formula for the Claiming of Detention: 

(a) A unit of detention time is a completed 15-minute period. The start and finish times for detention must be part of the patient record of the service. 

(b) All claims for detention must be accompanied by a claim for the preceding visit with the exception of Critical Escorts. 

(c) For specialists’ claims, the following times are considered to have been taken up with the visit code claimed: 

(i) Partial Assessment, Complex Assessment, Subsequent Hospital Visit - first 30 minutes of the service time,

 (ii) General Reassessment, Specific Reassessment - first 40 minutes, and 

(iii) Consultation (any type), General Assessment, Specific Assessment - first 60 minutes.

 (d) For General Practitioners’ claims, detention time units are calculated beginning at the time the patient encounter commences.