Well Baby Care
There are several services provided to healthy infants during their first two years of life. Below is a synopsis of typical services and tariffs 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 after birth.
The routine initial complete examination of a newborn usually does not satisfy the criterion of an “urgent /emergent” service. Therefore, after-hour premiums are generally not payable in addition to the examination fee. Suppose the baby displays an abnormal symptom or a particular problem during pregnancy or labour. In that case, 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. Doctors Manitoba recommends including a remark 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 should claim Tariff 8520 Hospital care — per day for all days, except the day of the complete examination service.
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 a visit where a baby is examined for immunization and to provide parents with reassurance and counselling on safety, nutrition, developmental and behavioural issues.
Physicians who perform regularly scheduled visits for Well Baby Care services should be claiming one of two tariffs:
- Tariff 8529 — for paediatricians and family physicians
- Tariff 8403 — 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 also (e.g., a paediatrician for a two-month Well Baby Care 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 claims for Well Baby Care visits for a single patient.
Whenever the physician must examine an ill infant during the first two years of life, the appropriate office/hospital with the corresponding ICD code for the diagnosis should submit the Care is no longer claimed after a baby has reached two years of age. Then make claims for the annual physical examinations of asymptomatic children under Tariff 8540 — Complete History and Physical Examination. Claim all other examinations under the appropriate office/hospital visit tariffs