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    Health Service Code 03.03KA

    Special callback to hospital emergency/outpatient department, AACC, UCC, auxiliary hospital or nursing home, when specially called from home or office, weekday, (0700-1700 hours)

    NOTE:

    Refer to the notes following HSC 03.03MD.

    Additional notes:
    • Listed under 03.03MD - Special callback to hospital emergency/outpatient department, AACC, UCC, auxiliary hospital or nursing home, when specially called from home or office, any day (2400-0700 hours):
      1. For hospital emergency/outpatient department, AACC, UCC refer to GR 15.3.
      2. For auxiliary hospital and nursing home visits, refer to the following notes:
        • Benefits for HSCs 03.03KA, 03.03LA, 03.03MC, 03.03MD may only be claimed when the physician is requested to attend a patient, by the patient, the patient's relatives or a health care provider of the facility involved in managing the patients care.
        • HSC 03.03EA may be claimed in addition to a special callback to an auxiliary hospital or nursing home.
        • HSC 03.03D may be claimed for palliative care or acute inter-current illness.
        • HSC 03.03DF may only be claimed where HSC 03.03D has been claimed for palliative care or acute inter-current illness in an auxiliary hospital or nursing home. Special callback benefits (03.03KA, 03.03LA, 03.03MC, 03.03MD) may be claimed in addition.
        • Benefits for HSCs 03.03KA, 03.03LA, 03.03MC, 03.03MD are payable based on the time at which the encounter commences.
        • The physician responds to such a call from outside the auxiliary hospital or nursing home, on an unscheduled basis.
        • The patient is attended on a priority basis.
        • Special callback benefits (HSCs 03.05N, 03.05P, 03.05QA, 03.05QB, 03.05R) may not be claimed in addition.
    Category:V Visit
    Base rate:$76.07

    AMA billing tips:

    • Maximums that include both callbacks to in- and outpatients per physician per day apply:

      • 03.03KA or 03.05N — Maximum five or any combination on any weekday (07:00-17:00 hours).
      • 03.03LA or 03.05P — Maximum five or any combination on any weekday (17:00-22:00 hours).
      • 03.03LA or 03.05R — Maximum 15 or any combination on any weekend day or statutory holiday (07:00-17:00 hours).
      • 03.03MC or 03.05QA — Maximum two or any combination any day (22:00-24:00 hours).
      • 03.03MD or 03.05QB — Maximum seven or any combination any day (24:00-07:00 hours).

    Fee modifiers:

    No modifiers.

    Governing Rules:

    • 5.2.1

      HSCs 03.03KA, 03.03LA, 03.03MC and 03.03MD may be claimed when a physician is specially called from home or office to a hospital emergency department, AACC or UCC to attend one patient. Maximums apply, see GR 15.11.

    • 5.2.2

      If a physician is in a hospital, AACC or UCC for any purpose and is asked to see another patient in the hospital emergency room or the same AACC or UCC, HSCs 03.03KA, 03.03LA, 03.03MC, 03.03MD do not apply. Benefits may be claimed for the applicable visit or procedure.

    • 15.5

      Only one unscheduled service or special callback benefit may be claimed for each encounter with a patient. In the event of a special callback, the following visit services may be claimed in addition: HSC 03.02A, 03.03A, 03.03B, 03.04A, 03.03DF or 03.03EA.

    • 15.6

      The unscheduled service and special callback benefit must be claimed according to the time at which the encounter commences and not from the time of the call for attendance.

    • 15.7.2

      Claims for special callbacks must meet all of the following conditions:

      1. a special call for attendance is made on the patient's behalf;
      2. the physician responds to such a call from outside the hospital, auxiliary hospital, nursing home, AACC or UCC on an unscheduled basis;
      3. the patient is attended on a priority basis;
      4. there is direct attendance by the physician.
    • 15.8

      Special callback benefits may not be claimed for subsequent patients seen during the same callback or in association with another service during the same encounter. However:

      1. HSC 03.03AR may be claimed for second and subsequent hospital inpatients.
      2. for second and subsequent emergency/outpatients, or AACC or UCC patients seen during the same callback, see GR 5.2.3.
      3. HSCs 03.03DF and 03.03EA may be claimed in addition to a callback in accordance with GR 15.5.
    • 15.11.1

      A maximum of five (5) special callbacks, either HSC 03.03KA, 03.05N or any combination thereof may be claimed, per physician, in any given weekday day. The weekday day is defined as Monday - Friday (0700 - 1700 hours).