Health Service Code 03.05QB
Special callback to hospital inpatient, (2400-0700 hours)
NOTE:
Refer to notes following 03.05R.
| Category: | V Visit |
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| Base rate: | $151.54 |
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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:
15.3 UNSCHEDULED SERVICES/SPECIAL CALLBACKS - AACC, UCC, HOSPITAL INPATIENT, OUTPATIENT AND EMERGENCY DEPARTMENTS
Benefits for UNSCHEDULED services (modifier SURC) and special callback HSCs 03.03LA, 03.03MC, 03.03MD, 03.05P, 03.05QA, 03.05QB and 03.05R are intended to cover a degree of disruption that a physician would have to experience to provide such services during:
- the evening on weekdays (1700 - 2200 hours),
- the day and evening on weekends and statutory holidays (0700 - 2200 hours)
- any night of the week (2200 - 0700 hours)
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:
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:
- a special call for attendance is made on the patient's behalf;
- the physician responds to such a call from outside the hospital, auxiliary hospital, nursing home, AACC or UCC on an unscheduled basis;
- the patient is attended on a priority basis;
- 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:
- HSC 03.03AR may be claimed for second and subsequent hospital inpatients.
- for second and subsequent emergency/outpatients, or AACC or UCC patients seen during the same callback, see GR 5.2.3.
- HSCs 03.03DF and 03.03EA may be claimed in addition to a callback in accordance with GR 15.5.
15.11.5
A maximum of seven (7) HSC 03.03MD, 03.05QB or any combination thereof may be claimed, per physician, any day, (2400 - 0700 hours).
