Health Service Code 03.05FA
Follow-up care of a patient remaining in an emergency department awaiting further evaluation, treatment and/or waiting for a bed, transfer to another facility, or requiring extended care by a physician, weekday, 1700 to 2200 hours, weekend and statutory holiday, 0700 to 2200 hours
NOTE:
Refer to the notes following HSC 03.05FB.
Additional notes:
Listed under
03.05FB - Follow-up care of a patient remaining in an emergency department awaiting further evaluation, treatment and/or waiting for a bed, transfer to another facility, or requiring extended care by a physician, any
day, 2200 to 0700 hours:
- HSCs 03.05F, 03.05FA and 03.05FB may not be claimed on the same shift by the physician who provided the initial assessment.
- HSCs 03.05F, 03.05FA and 03.05FB may only be claimed once per patient per emergency room shift.
- HSCs 03.05F, 03.05FA and 03.05FB may only be claimed by physicians on rotation duty in an emergency department, or providing first call coverage in an emergency department with greater than 25,000 visits per year.
- Should the patient remain in the emergency room awaiting an in-patient bed after admission to hospital, HSCs 03.05F, 03.05FA and 03.05FB may not be claimed by the emergency room physician.
| Category: | V Visit |
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| Base rate: | $29.36 |
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AMA billing tips:
Rotation-duty emergency department criteria (03.05F, 03.05FA, 03.05FB):
- May only be claimed by physicians on rotation duty or providing first-call coverage in an emergency department with more than 25,000 visits per year.
- May not be claimed on the same shift by the physician who provided the initial assessment.
- May not be claimed when the patient has been admitted to the hospital but is awaiting an inpatient bed.
- May only be claimed once per patient per shift.
Fee modifiers:
| Type | Code | # of calls | Explicit | Action | Amount |
|---|
| CARE | CMXV20 | | Yes | Increase Base By | $15.74 |
| CARE | CMXV35 | | Yes | Increase Base By | $31.51 |
Governing Rules:
5.1.1
HSCs 03.05CR, 03.05DR, 03.05ER, 03.05F, 03.05FA, 03.05FB may only be claimed by physicians on rotation duty or by physicians who are providing first call coverage in an emergency department that has greater than 25,000 visits to the emergency room per year. HSCs 03.05FR, 03.05GR, 03.05HR, 03.05FC, 03.05FD and 03.05FE may only be claimed by physicians on rotation duty in an AACC or UCC.
5.1.6
If a physician on rotation duty in a hospital emergency department or a physician who is providing first call coverage in an emergency department that has greater than 25,000 visits to the emergency room per year and a second physician submit claims for visits to the same patient on the same day, the following rules apply:
- If the patient is not admitted, the physician on rotation duty or the physician who is providing first call coverage in an emergency department that has greater than 25,000 visits to the emergency room per year may be paid and the second physician may only be paid when specially called to attend that specific patient or in the case of follow-up care as described under HSCs 03.05F, 03.05FA, 03.05FB.
- If the patient is admitted, both physicians may be paid and in this case, the second physician does not have to be specially called to claim for inpatient services.
