Audit tip: Billing for call-out charges

As defined in the Doctors of BC Guide to Fees, call-out charges are applicable when a physician is called to render emergency or non-elective services and must travel from one location to another to attend the patient. All call-out fee items must state the time of call and time of service rendered.

If the physician remains at the same site to answer the call, such as being called from one location to another within the same hospital, the fee for call-out charges is not applicable.

The following examples describe scenarios that do not qualify for call-out charges:
•    A physician is called at 1 p.m. and arranges to see a patient after a clinic or OR shift, after 6 p.m. This is considered to be a booked appointment.
•    A physician is located in the hospital or emergency department and is called after hours to see a patient in either the emergency department or elsewhere in the same hospital.
•    Multiple patients are seen during the same call out. Billing for separate call-out charges is incorrect.
•    A visit at 6:05 p.m. is billed to fee code 01200, with the call placed prior to 6 p.m. A call-out charge should not be billed when it appears the visit was timed to collect the fee.

Medical inspectors look for proper documentation in the patient’s chart or dictation to support the criteria to bill a call-out fee code—time called and service rendered. Having little or no documentation in your clinical records to support your claim is interpreted as “you didn’t do the work.”

Always refer to the Doctors of BC Guide to Fees and its Preamble for interpretations of all fees.
—Keith J. White, MD
Chair, Patterns of Practice Committee

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This article is the opinion of the Patterns of Practice Committee and has not been peer reviewed by the BCMJ Editorial Board. For further information contact Juanita Grant, audit and billing advisor, Physician and External Affairs, at 604 638-2829 or jgrant@doctorsofbc.ca.