Family physicians may claim tariff 8594, Complete History and Physical Examination – Unassigned Patient, under certain circumstances when performing complete examinations on patients in hospital.
Tariff 8594 may be claimed when:
- the examination is a complete history and physical examination (as specified in tariff 8540);
- the purpose of the examination is to either:
- assess whether admission to hospital is appropriate, or
- admit the patient to hospital under the care of the examining physician; and
- the examination is performed on an “unassigned patient”.
For the purpose of tariff 8594, an “unassigned patient” is one with respect to whom the examining physician has not claimed tariff 8540, 8500, 8498, 8450, 8424, 8420, 8421 or 8499 within the last 12 consecutive months prior to the examination. The fact that the examining physician may have submitted claims under other tariffs including 8594 during the last 12 months with respect to the patient being examined is irrelevant.
NOTE: If the examining physician is part of the patient’s regular family physician’scall group, and the regular family physician has claimed tariff 8540, 8500, 8498, 8450, 8460, 8424, 8420, 8421 or 8499 in respect of the patient being examined within the last 12 months, the examining physician cannot claim under tariff 8594.
This restriction on billing 8594 does not apply to physicians providing “Doc of the Day” or “Seven Oaks Hospital Family Physician” services.
Updated: December 2016