Criteria:
All of the following criteria must be met:
- This code may only be claimed for physician services provided to patients in active treatment hospitals, nursing homes, auxiliary hospitals, AACC or UCC in the after hours. ("After hours" is defined as 5 p.m. to 7 a.m. on weekdays and any time on weekends, statutory or designated holidays.)
- Patient must have been seen on the same date of service by the same physician claiming the 03.01AA.
- Physician time spent on the following activities may be included in the total time claimed for 03.01AA:
- Charting.
- Reviewing (but not waiting for lab or DI results).
- Consulting with other health providers on the service about the patient’s care.
- Writing a referral/consultant letter.
- Any other physician activities included in managing the patient’s care.
- Bill at the start of the encounter or during the time period where the bulk of the time was spent (e.g., if the encounter starts at 21:55 and ends at 22:10, claim 03.01AA TNTP01).
- If the time spent managing patient care crosses over two time periods, more than one modifier can be used (e.g., if the encounter starts at 21:00 and ends at 23:45, claim 03.01AA TEV04 TNTP07).
- If the time spent managing patient care crosses two dates of service, separate the claim into two claims with two dates of service.
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For example, if the encounter starts on day one at 21:00 and ends on day two at 00:45, the claim would look like this:
- Claim one for day one, 03.01AA TEV04 TNTP08.
- Claim two for day two, 03.01AA TNTA03.
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Please do not forget that the total time premiums claimed cannot exceed the total time spent managing patient care for that shift. For example, if the total after-hours time spent in the hospital was 10 hours, subtract the time spent eating dinner and other non-patient-related activities.
The remainder will be the “total time spent managing patient care” and, therefore, the maximum period of time that is eligible for time premiums. Submitting claims for time premiums that total more time than was actually spent managing patient care is considered inappropriate billing.
This fee code may not be claimed for the following:
- Stand-by time.
- Completing discharge summaries or clinical notations after the patient has been discharged unless the patient was seen on the same day.
- More than four units per hour per physician may not be claimed (the time claimed cannot exceed actual time spent managing patient care).
- Providing uninsured services.
- Non-physician time.
Additional information:
- This HSC is claimed on a time basis and pays strictly for the time spent managing the patient’s care in relation to an insured service.
- 03.01AA is claimed in 15-minute units.
- Only the time that the physician actually spent managing patient care is billable.
- 03.01AA is billable in addition to other services at the same encounter on the same date of service for after-hours work.
- Modifiers that apply to 03.01AA are as follows:
- TEV (weekdays 17:00-22:00). Maximum of 20 units.
- TNTP (22:00-24:00). Maximum of 8 units.
- TNTA (24:00-07:00). Maximum of 28 units.
- TWK (weekends 07:00-22:00). Maximum of 60 units.
- TST (07:00-22:00 statutory holidays). Maximum of 60 units.
- TDES (designated statutory holidays 07:00-22:00). Maximum of 60 units.
- A claim for 03.01AA must include a modifier that signals the time of day and the length of time it took to provide the service. For example, if the service started at 20:15 hours and took 45 minutes, the claim for 03.01AA would look like this: HSC 03.01AA modifier TEV03.
- The “TEV” portion of the modifier signals that the service was provided in the evening.
- The “03” portion of the modifier signals that the service took approximately 45 minutes. Please note: Claims for overlapping time may not be submitted. Only 4 units are billable per hour per physician.
Some examples
Billing scenario 1
On a Monday night at 22:30, an internist gets a call from the nurse on the ward requesting that s/he come on a priority basis to the hospital to assess a patient’s condition. The total time spent managing the patient's care is 38 minutes.The claim would look like this:
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03.05QA in-patient callback (22:00-24:00).
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03.03DF hospital visit in association with a callback.
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03.01AA (Modifier) TNTP03.
Billing scenario 2
On a Saturday at 02:00, a GP gets a call from the hospital to see a patient in the non-rotation duty (GR 1.13) emergency department on a priority basis. Due to the nature of the illness/injury, the physician takes a full history and performs a complete physical (appropriate to their specialty), the service lasts for 50 minutes. (Please note: Claims for overlapping time may not be submitted. Only 4 units are billable per hour per physician.) The claim would look like this:
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03.03MD Callback (24:00-07:00).
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03.04A (Modifier) CMXC30.
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03.01AA (Modifier) TNTA04.
Governing rules
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