Infants in a Neonatal Intensive Care Unit requiring full monitoring both invasive and non-invasive and requiring IV therapy or parenteral alimentation but without ventilator support.
Neonatal Intensive Care
These listings may be used for patients receiving neonatal intensive care and are intended for use by the Neonatologist or Pediatrician (or Team) in charge of the patient. These listings may be used by physicians providing direct bedside care to critically ill and unstable patients who are in need of intensive treatment such as ventilatory support, haemodynamic support including vasoactive medications or prolonged resuscitation. They are to be billed only on sick or preterm infants requiring intensive care. They are also for infants who are more than 28 days old, who have neonatal problems related to prematurity, etc. These listings do not apply to non-ventilated stable patients admitted to a special care unit for routine post-op care. These fees are not for the infant who is stable and only requiring a period of observation. Neither are they for the infant who needs a short course of prophylactic antibiotics. It would be unusual to bill these fees on an infant whose period of care in the NICU lasted less than 48 hours Consultation and visit fees would be appropriate.
These neonatal intensive care fees only apply to physicians who are directly involved in the bedside care of patients in the Critical care medicine Areas. “Preamble to the Payment Schedule” applies:“
C. 18. Guidelines for payment for services by residents and/or interns.
When patient care is rendered in a clinical teaching unit or other setting for clinical teaching by a health care team, the medical practitioner responsible shall be personally identified to the patient at the earliest possible moment. No fees may be charged in the name of the responsible staff physician for services rendered by an intern or resident prior to the identification taking place. Moreover, the responsible staff physician must be in the clinical teaching unit and/or immediately available to intervene (immediately available means on-site).
For a medical practitioner who supervises two or more procedures or other services concurrently through the use of residents, interns or other members of the team, total billings must not exceed the amount that a medical practitioner could bill in the same time period in the absence of the other These neonatal intensive care fees only apply to physicians who are directly involved in the bedside care of patients in the Critical care medicine Areas. “Preamble to the Payment Schedule” applies:
Included in these daily composite fees are the initial consultation or assessment, subsequent visits and examinations as required in any given day. Also included are: family counselling, emergency resuscitation, insertion of arterial, venous, Swan-Ganz, CVP or urinary catheters, intravenous lines, interpretation of blood gases, insertion of nasogastric tubes, infusion of pharmaceutical agents including TPN, endotracheal intubation and artificial ventilation and all other necessary respiratory support. Exchange transfusion is not included in these fees and not all infants requiring an exchange transfusion are critically ill.
Out-Of-Office Hours Call-out Charges may still apply for special calls back to the hospital and may be billed in conjunction with a no charge visit. If a patient is discharged from the unit for more than 48 hours and is readmitted, second day rates again apply. If the patient is re-admitted within 48 hours of discharge, billing continues under fee code billed at discharge, unless acuity level changes. If a patient changes acuity level up or down then the appropriate second day rate applies. A note record is required indicating the change in acuity level. Fee item 00505 (Emergency Visit) may not be billed by the person claiming these fees.
Call-out charges are billable with the neonatal Critical care medicine fee items. Historically, these have not been included in the neonatal fees and may be billed separately.Members of the team billing the Neonatal Guide cannot be receiving other payments (e.g.: fees, alternative or sessional payments) for the clinical care of the patient.