Fee Navigator®

    Governing Rule: 5.1

    EMERGENCY DEPARTMENT/AACC/UCC VISITS/ASSESSMENTS BY ROTATION DUTY PHYSICIANS OR BY PHYSICIANS PROVIDING FIRST CALL COVERAGE IN AN EMERGENCY DEPARTMENT THAT HAS GREATER THAN 25,000 VISITS TO THE EMERGENCY ROOM PER YEAR

    • 5.1.1

      HSCs 03.05CR, 03.05DR, 03.05ER, 03.05F, 03.05FA, 03.05FB may only be claimed by physicians on rotation duty or by physicians who are providing first call coverage in an emergency department that has greater than 25,000 visits to the emergency room per year. HSCs 03.05FR, 03.05GR, 03.05HR, 03.05FC, 03.05FD and 03.05FE may only be claimed by physicians on rotation duty in an AACC or UCC.

    • 5.1.2

      Only one of HSCs 03.05CR, 03.05DR, 03.05ER, 03.05FR, 03.05GR or 03.05HR may be claimed by either the same or a different physician, on the same date of service when the patient has remained in the emergency department, AACC or UCC.

    • 5.1.3

      Deleted

    • 5.1.4

      When the patient has been discharged from an emergency department, AACC or UCC and returns on the same day, another visit by the same or different physician may be claimed.

    • 5.1.5

      HSCs 13.99H and 13.99HA may not be claimed in association with another visit HSC. Time units may be claimed on a cumulative basis.

    • 5.1.6

      If a physician on rotation duty in a hospital emergency department or a physician who is providing first call coverage in an emergency department that has greater than 25,000 visits to the emergency room per year and a second physician submit claims for visits to the same patient on the same day, the following rules apply:

      1. If the patient is not admitted, the physician on rotation duty or the physician who is providing first call coverage in an emergency department that has greater than 25,000 visits to the emergency room per year may be paid and the second physician may only be paid when specially called to attend that specific patient or in the case of follow-up care as described under HSCs 03.05F, 03.05FA, 03.05FB.
      2. If the patient is admitted, both physicians may be paid and in this case, the second physician does not have to be specially called to claim for inpatient services.
    • 5.1.7

      If a physician working in an AACC or UCC, and a second physician submit claims for visits to the same patient on the same day, the physician working in an AACC or UCC may be paid and the second physician may only be paid when specially called from outside the facility to attend that specific patient.