Several services are provided to healthy infants during their first two years of life. Below is a synopsis of the typical pattern of services and tariffs that should be claimed for care provided during this time.
- Generally, a Complete History and Physical Examination (tariff 8540) of a newborn will occur within the first 24 hours of birth.
The routine initial complete examination of a newborn usually does not satisfy the criterion of an “urgent /emergent” service. Therefore, after hours premiums are not normally payable in addition to the examination fee. If the baby displays an abnormal symptom or there has been a particular problem during a pregnancy or labor, then it may be medically necessary to conduct a complete examination of the newborn promptly after birth. Under these circumstances, after hours premiums, where applicable, are payable in addition to the examination fee. It is recommended that a remark be included with your claim.
- Hospital visits, as necessary, will also occur for the remainder of the newborn’s hospital stay. While the baby is in hospital, the physician of record should claim tariff 8520 Hospital care per day for all days, except the day the complete examination service was rendered
Where the initial examination of the baby takes place on the same day as the birth, claim tariff 8540 for the examination and tariff 8520 from the day after birth until the day of discharge inclusive.
Where the initial examination of the baby takes place on the day following birth, claim tariff 8520 for the first day in hospital, tariff 8540 for the examination on the second day, and then recommence claiming tariff 8520 on the third day until the day of discharge inclusive.
A well baby care visit is commonly described as a vit where a baby is examined for the purpose of immunization and/or provided parents with reassurance and counselling on safety, nutrition, developmental and behavioral issues.
- Physicians who perform regular scheduled visits for “well baby care” services should be claiming one of two tariffs:
- Tariff 8529 – for paediatricians and family physicians
- Tariff 8529 – for all other blocs of practice
- Well baby care visits generally occur at one or two weeks and two, four, six, nine, twelve and eighteen months. For most babies, these visits coincide with routine childhood immunizations.
Claim well baby care and all immunizations provided in addition (e.g., a paediatrician for a two-month well baby visit would claim tariff 8529 plus tariff 8802, DTaP-IPV-Hib – first dose plus tariff 8681, Pneumococcal conjugate.)
- Physicians billing tariff 8529 for well baby care do not have to meet the criterion of a minimum of 10 minutes of physician time.
- There is no limit to the number of well baby care visits that may be claimed for a single patient.
- Whenever it is necessary for the physician to conduct an examination of an ill infant during the first two years of life, the appropriate office/hospital visit should be claimed with the corresponding ICD code for the diagnosis.
- Well baby care is no longer claimed after a baby has reached two years of age. After two years age, annual physical examinations of asymptomatic children may be claimed under tariff 8540 Complete History and Physical Examination. All other examinations should be claimed under the appropriate office/hospital visit tariffs.
Updated: May 2017