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.

An Anaesthesiologist may claim a specific reassessment for patient visits for the management of post-operative obstructive sleep apnea where the billing physician is not also claiming per diem fees and/or non-IOP procedural fees. A maximum of one specific reassessment may be claimed for this purpose per patient per period of admission. 

Subsequent Hospital Visits (SHVs) 

SHVs may be claimed for continuing care of hospital in-patients by attending physicians. These visits are payable on a per diem basis and may only be claimed once for each patient day regardless of the number of actual visits to a patient on any one day. Information on the patient’s hospital chart satisfies documentation requirements for SHVs. Premiums for any additional “Special Visits” as defined in this Preamble may be applicable.