C262

PDF page 57 / GP43

Definition:
A subsequent visit is any routine assessment in hospital following the hospital admission assessment.
          Attendance at Surgery: If, in the interest of the patient, the referring physician is asked to be
          present by the patient or the patient’s representative, but does not assist at the procedure, the
          attendance at surgery by the referring physician constitutes a hospital subsequent visit.
          Multidisciplinary care: Except where a single service for a team of physicians is listed in this
          Schedule (e.g. the weekly team fee for dialysis), when the complexity of the medical condition
          requires the services of several physicians in different disciplines, each physician visit
          constitutes a subsequent visit.
Payment rules:
  1. Except in the circumstances outlined in paragraphs 2 and 3, or when a patient is referred from
     one physician to another (see Claims submission instruction below), subsequent visits are
     limited to one per patient, per day for the first 5 weeks after admission, 3 visits per week from 6
     to 13 weeks after admission, and 6 visits per month after 13 weeks. Services in excess of the
     limit are not eligible for payment.
    2. After 5 weeks of hospitalization, any assessment in hospital required as a result of an acute
       intercurrent illness in excess of the weekly or monthly limits set out above constitutes C121 –
       “additional visit due to intercurrent illness”. The weekly or monthly limits set out above do not
       apply to additional visits due to intercurrent illness.
    3. Pediatric subsequent visits (C262) are limited to one per patient, per day for the duration of the
       admission.
    4. When a physician is already in the hospital and assesses one of his/her own patients or patients
       transferred to his/her care, the service constitutes a subsequent visit. If a physician assesses
       another physician’s patient on an emergency basis, the General Listings (“A” prefix) apply.

PDF page 301 / A173

CONSULTATIONS AND VISITS
 PAEDIATRICS (26)
        EMERGENCY OR OUT-PATIENT DEPARTMENT (OPD)
         Physician in hospital but not on duty in the Emergency Department when seeing patient(s) in
         the Emergency or OPD - use General Listings.
     NON-EMERGENCY HOSPITAL IN-PATIENT SERVICES
      See General Preamble GP40 to GP48. For emergency calls and other special visits to in-
      patients, use General Listings and Premiums when applicable - see General Preamble GP65
      to GP78.
   C265 Consultation............................................................................  190.35
   C260 Special paediatric consultation - subject to the same conditions
           as A260 .............................................................................. 342.25
   C662 Extended special paediatric consultation - subject to the same
           conditions as A662 .............................................................       442.40
   C667 Neurodevelopmental consultation - subject to same conditions
           as A667 .............................................................................. 456.80
   C665 Prenatal consultation - subject to the same conditions as A665                            105.50
   C565 Limited consultation ................................................................     104.70
   C266 Repeat consultation ................................................................      104.70
   C263 Medical specific assessment ..................................................             95.75
   C264 Medical specific re-assessment..............................................               70.75
   C661 Complex medical specific re-assessment...............................                      86.35
     Subsequent visits
   C262 - per visit ...............................................................................   40.05
     Subsequent visits by the Most Responsible Physician (MRP)
      See General Preamble GP44 to GP45 for terms and conditions.
   C122 - day following the hospital admission assessment..............                               71.80
   C123 - second day following the hospital assessment ..................                             71.80
   C124 - day of discharge .................................................................          71.80
   C126 - day of discharge, medically complex patient (see A13 for
          terms and conditions) .........................................................             95.10
     Subsequent visits by the MRP following transfer from an Intensive Care Area
      See General Preamble GP46 for terms and conditions.
   C142 - first subsequent visit by the MRP following transfer from an
          Intensive Care Area............................................................ 71.80
   C143 - second subsequent visit by the MRP following transfer from
          an Intensive Care Area.......................................................   71.80
   C121 Additional visits due to intercurrent illness (see General
          Preamble GP43)..................................................... per visit               40.05
   C268 Concurrent care .......................................................... per visit          40.05
   C982 Palliative care (see General Preamble GP50)............ per visit                             40.05

Master, record 598. Record Layout PDF, page 1.

C26220260401999999990000000000000000000000000004005000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.