High Risk Prenatal Assessment

A high risk prenatal assessment is an assessment by a maternal-fetal medicine specialist requiring a minimum of 20 minutes in direct contact with the patient for the management of a documented significant maternal and/or fetal risk factor(s) where the mother and/or fetus are at significant risk for serious complications during the pregnancy. The service is eligible for payment only if start and stop times of the service are recorded in the patient’s permanent medical record.

Home Visits by General Practitioners 

An Elective Home Visit rendered by a General Practitioner is a visit to a patient’s home or normal place of residence which is initiated by the physician in the management of known illness. The fee for elective home visits is the same regardless of the time that the service is rendered, or the type of service provided.

A Non-Elective Home Visit rendered by a General Practitioner is a visit that is requested by the patient or by the patient’s attendant and which is made by the physician on the same day. The fee payable for a non-elective home visit is determined by the time or day that the service is rendered. The time of service must be documented on the record for the visit.

For Extra Patient(s) Seen, only fee code 252 or 292 as applicable may be claimed. 

In-Patient Surcharges 

Fee code 355 may be claimed by General Practitioners providing continuing care of hospital in-patients. It is payable during the first seven days of an admission on a per diem basis. It can be billed in addition to the applicable admission assessment code, or SHV code, and code 359.

Fee code 359 may be claimed by General Practitioners providing continuing care of hospital in-patients. It is payable once during a period of admission on the day the patient is discharged from hospital. It can be billed in addition to the applicable SHV code and code 355. The billing physician is responsible for preparing the discharge summary, the discharge prescriptions and follow up care as necessary.

Fee code 359 may be claimed by Internal Medicine Specialists and Sub-specialists providing continuing care of hospital in-patients. It is payable once during a period of admission on the day the patient is discharged from hospital. It can be billed in addition to the applicable SHV code. The billing physician is responsible for preparing the discharge summary, the discharge prescriptions and follow up care as necessary.

Fee codes 352 and 353 may be claimed by Psychiatrists providing continuing care of hospital in-patients as the attending physician. Fee code 352 is payable during days 1 to 14 of an admission on a per diem basis. It can be billed in addition to the admission assessment code, or codes 356 and 359. Fee code 353 is payable during days 15 to 28 on a per diem basis and can be billed in addition to codes 356 and 359.