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Special Callback to Hospital Inpatients (03.05N, P, R, QA, QB)

Billing for a special call on a patient.

Criteria:

All of the following criteria must be met: 

  • A special call for attendance is made on the patient’s behalf.
  • The physician responds from outside the facility (hospital) on an unscheduled basis.
  • There is direct physician attendance on a priority basis.
  • The physician must claim based on the time the encounter commences and not the time of the call.
  • Maximums that include callbacks both to in- and outpatients per physician apply:
    • 03.03KA and 03.05N: Maximum five or any combination on any weekday (0700-1700 hours).
    • 03.03LA and 03.05P: Maximum five or any combination on any weekday (1700-2200 hours).
    •  03.03LA and 03.05R: Maximum 15 or any combination on any weekend day or stat holiday (0700-1700 hours).
    • 03.03MC and 03.05QA:  Maximum two or any combination any day (2200-2400 hours).
    • 03.03MD and 03.05QB: Maximum seven or any combination any day (2400-0700 hours).

These fee codes may not be claimed for the following:

  • Second and subsequent patients seen at the same callback. For second and subsequent patients seen at the same callback, use 03.03AR (if the criteria for 03.03AR are met).
  • Encounters where the physician has initiated the service (i.e., scheduled it with the patient, asked the patient to return later in the day or returned to observe the patient.
  • If the second encounter (the callback) is a continuation of a previous service (e.g., diagnostics ordered at the first encounter, results are ready, physician is called to review and provide treatment).

The second encounter may not be claimed as a callback, as it is a continuation of the first service. 

Callbacks cannot be claimed in addition to psychiatric services, procedures, anesthetics or consultations.

Additional information:

  • Callbacks should be claimed in addition to a visit:
  • Callbacks can be claimed in addition to a visit when the purpose of the callback is to pronounce a patient’s death (G.R. 4.15). There is nothing billable for completing a death certificate. All criteria for a callback must still be met. Otherwise, only a visit item may be claimed for pronouncing the patient dead.
  • You can claim the After-hours time premium (03.01AA) for the total time spent managing patient care when services are provided after hours in a regional facility:
    Review After-hours Time Premium (03.01AA) >>

Access a chart that breaks down callbacks into their billable components:
Download the Callback to a Hospital Inpatient on a Priority Basis chart >> 

Related fee codes:

Governing rules:

G.R. 15, 4.15

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