The physician shall be remunerated for this care on a per visit basis with a maximum of one
visit every five days. If the patient is seen for the first time on admission, a general or specific assessment may apply in addition to the above fees. In acute illnesses requiring special
visits, premiums also apply in addition to fees allowable under the above formula.
Complex Assessment
A Complex Assessment is payable to physicians when they are providing dedicated On-Site
Emergency Department Coverage at designated hospital facilities . The
following services qualify for claiming a Complex Assessment:
(a) Evaluation of a new or existing medical condition that necessitates a detailed medical
history, review of previous medical records and necessary physical examination of
three or more organ systems. It may include a review of diagnostic tests and the
initiation of appropriate therapy/treatment. For the purposes of claiming this code the
organ systems are defined as: cardiovascular, respiratory, digestive, genitourinary,
musculoskeletal, hemolymphatic, integumentary, nervous, ears-nose-throat,
ophthalmic and mental.
OR
(b) Prolonged observation and/or continuous therapy and multiple reassessments (not
including discharge assessment) of patients whose illness requires it. Please note
that payment for the discharge assessment is included in the complex assessment fee
and is not billable in addition.
OR
(c) Management of patients presenting with life or limb threatening illness or injury that
requires immediate evaluation and/or intervention and/or emergent treatment by the
physician.
