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.

Dermatology Consultation in a DHCS Designated Long Term Care Facility

This is payable only to Dermatology Specialists. It is applicable to claims for elective consultative services requested by a staff General Practitioner or Nurse Practitioner on behalf of a patient with a complex dermatological problem. The service is rendered to a resident of a DHCS Designated Long Term Care Facility in that facility. DHCS Designated Long Term Care Facilities are listed in Appendix C of this Preamble. The facility number must be entered on the claim. The service should be documented on the resident’s chart.

Special visit premiums do not apply to elective consultations. Emergency consultations and special visits must be billed using appropriate consultation, visit and premium fee codes.

High Risk Perinatal Consultation by Maternal-Fetal Medicine Specialist: A high risk prenatal consultation is a consultation by a maternal-fetal medicine specialist requiring a minimum of 40 minutes of 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.

A regular consult would still apply in cases where:

1. in cases where the condition does not pose a significant risk for pregnancy (for example, the patient is referred for hypothyroidism, but upon seeing the patient she is no longer hypothyroid or is well controlled on meds.)