Callbacks to Long-Term Care

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, LTC) on an unscheduled priority basis.
  • There is direct physician attendance.
  • The claim must be based on the time the encounter begins and not the time of the call.
  • 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).

This fee code 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, returned to observe the patient or continued a previous service).
  • Callbacks cannot be claimed in addition to psychiatric services, procedures, anesthetics or consultations. (Surcharge modifiers may apply.)

Additional information:

  • Callbacks should be claimed in addition to a visit:
    • For inpatients — When 03.03D has been claimed at a previous encounter, 03.03DF should also be claimed.
    • For LTC or auxiliary hospital callbacks, use 03.03EA.

However, if the patient has acute intercurrent illness and requires more frequent visits, use 03.03DF (if 03.03D for the patient has previously been claimed for the same illness).

The admission date on the claim for the 03.03D will be the date the intercurrent illness started.

  • 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.
  • After-hours time premium (03.01AA) may be claimed for the total time spent managing patient care when services are provided after hours in a regional facility:
    Access After-hours Time Premium (03.01AA)

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

Related fee codes

  • 03.03AR Urgent or priority attendance on hospital inpatient or long-term care inpatient, at request of facility staff when physician is already on site.
    • May only be claimed by the patient's physician of record or by physicians working as part of an on-call rotation.
    • May not be claimed by physician extenders.
    • May only be claimed for direct attendance with the patient. 

Governing rules

G.R. 15, 4.15

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