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.)
