H007

PDF page 141 / A13

Payment rules:
          1.In addition to satisfying all of the elements and payment rules of subsequent visit by the MRP
            – day of discharge (see page GP45), C126 is only eligible for payment under the following
            conditions:
             a.the patient has been admitted to hospital for a minimum of 7 consecutive days,
             b.the patient has a minimum of three diagnoses that contributed to the length of stay, and
          2.The minimum amount of time dedicated to the provision of C126 must be 45 minutes,
            exclusive of time spent rendering any other separately billable intervention and personally
            rendered by the physician, or the service will be adjusted to a lesser paying fee.
          3.Only one of C124 or C126 is eligible for payment per hospital admission.
     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
   C008 Concurrent care .......................................................... per visit           40.05
   C010 Supportive care .......................................................... per visit           40.05
   C882 Palliative care (see General Preamble GP50)............ per visit                              40.05
     Attendance at maternal delivery for care of high risk baby(ies)
      Attendance at maternal delivery for high risk baby(ies) requires constant attendance at the
      delivery of a baby expected to be at risk by a physician who is not a paediatrician, and includes
      an assessment of the newborn.
   H007 Attendance at maternal delivery for care of high risk baby(ies)                 61.65

PDF page 533 / K3

OBSTETRICS
 PREAMBLE
  10. The listings for “Attendance at labour and delivery” and for “Attendance of obstetric
      consultant(s) at delivery” may not be claimed by any physician when a patient is transferred to a
      second physician for normal obstetrical care.
    11. Ordinary immediate care of the newborn is included in the labour-delivery fee and when the
        service is rendered by the anaesthesiologist, it is included in the anaesthetic benefit. A life
        threatening emergency situation requiring active resuscitation of the newborn provided by any
        physician may be claimed under codes G521, G522, G523. When indicated, endotracheal
        intubation and tracheo-bronchial toilet should be billed under G211 and not as G521, G522,
        G523.
    12. When an obstetrician routinely transfers all newborns to another physician, the latter may not
        claim a consultation for these transferals. If the baby is well, the physician should claim newborn
        care in hospital plus attendance at maternal delivery (H007/H267) if this service is provided. If
        the baby is sick, the physician may claim a general assessment and attendance at maternal
        delivery (H007/H267) if this service is provided plus daily visits for as long as his/her services
        are required.
    13. If an obstetrician who normally cares for newborns him/herself or transfers the care of newborns
        to a family physician, refers a newborn to a paediatrician because of the complexity, obscurity or
        seriousness of the case, the latter may claim for this service according to the following
        guidelines:
        a. If attendance at maternal delivery is provided, C263 may be claimed in addition to H267 if a
           general assessment of the baby is carried out. A postnatal consultation of the baby, (C265)
           may not be claimed in addition to attendance at maternal delivery (H267).
        b. If attendance at maternal delivery (H267) is not provided, a postnatal consultation (C265)
           may be claimed, if rendered, whether or not a prenatal consultation has already been
           claimed.
    14. Physicians may claim for assisted breech delivery under fee code P020 when the service
        includes spontaneous delivery to the umbilicus, with extraction of the shoulders, arms and
        head.
    15. See General Preamble GP103 for After Hours Premiums.
    16. If claims are being submitted in coded form, the obstetrician should add the suffix “A” to the
        listed procedural code, the assistant should add the suffix “B” to the listed procedural code, and
        the anaesthesiologist should add the suffix “C” to the listed procedural code.

Master, record 2427. Record Layout PDF, page 1.

H00720250401999999990000061650000000000000000000000000000000000000000000000

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.