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Special Callback to Hospital Outpatients, 03.03KA, 03.03LA, 03.03MC, 03.03MD

Billing for a special callback to a hospital outpatient.

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, AACC, UCC) on an unscheduled basis.
  • There is direct physician attendance on a priority basis.
  • The physician must claim based on the time the encounter starts and not the time of the call.
  • Maximums that include both callbacks to in- and outpatients per physician apply:
    • 03.03KA and 03.05N: Maximum five or any combination on any weekday (07:00-17:00 hours).
    • 03.03LA and 03.05P: Maximum five or any combination on any weekday (17:00-22:00 hours).
    •  03.03LA and 03.05R: Maximum 15 or any combination on any weekend day or statutory holiday (07:00-17:00 hours).
    • 03.03MC and 03.05QA: Maximum two or any combination any day (22:00-24:00 hours).
    • 03.03MD and 03.05QB: Maximum seven or any combination any day (24:00-07:00 hours).

These fee codes may not be claimed for the following:

  • For second and subsequent patients seen in the emergency department, use appropriate visit or procedure code.
  • 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).
  • 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.
  • Callbacks cannot be claimed for a second attendance in a non-rotation duty emergency department for cases where the patient:
    • Has been examined by a physician and is awaiting further evaluation, treatment
      and/or
    • Is waiting for a bed, transfer to another facility or requiring extended care.

Please see follow-up care in emergency department:
Review Follow-up Visits in Emergency, UCC or AACC >>

Additional information:

  • Callbacks should be claimed in addition to a visit:
    • For emergency department or outpatient callbacks, the appropriate visit code should be claimed, i.e., 03.02A, 03.03A, 03.03AZ, 03.04A, 03.04AZ, 03.03B, 03.03BZ.
    • For callbacks to long-term care:
      Review Callbacks to Long-Term Care >>
    • For callbacks to inpatients:
      Review Callbacks to Hospital Inpatients >>
    • For callbacks to the emergency department, the appropriate visit codes to claim in addition to the callbacks are 03.02A, 03.03A, 03.03AZ, 03.03B, 03.03BZ, 03.04A or 03.04AZ.
  • 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 may be claimed in addition 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 Hospital Outpatient/LTC on a Priority Basis chart >>

Related fee codes:

Governing rules:

G.R. 15, 4.15

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