A. Consultations: Definitions
(i) First consultation: Refers to a situation where a medical practitioner personally takes down a patient's medical history, performs an appropriate clinical examination and, if indicated, prescribes or administers treatment.
(ii) Subsequent consultation: Refers to a voluntarily scheduled consultation performed for the same condition within four (4) months after the first consultation (although the symptoms or complaints may differ from those presented during the first consultation). It may imply taking down a medical history and/or a clinical examination and/or prescribing or administering of treatment and/or counselling.
(iii) Hospital visits: Where a procedure or operation was done, hospital visits are regarded as part of the normal after-care and no fees may be levied. Where no procedure or operation was carried out fees may be charged for hospital visits according to item 0109. Dates of hospital visits must be specified.
B. Normal hours versus after-hours: Normal working hours refer to the period 08:00 to 17:00 on Mondays to Fridays; the period 08:00 to 13:00 on Saturdays; as well as all other periods voluntarily scheduled (even when for the convenience of the patient) by a medical practitioner for the rendering of services. All other periods are regarded as after-hours. Public holidays are not regarded as normal working days and involuntarily scheduled work performed on such days is regarded as after-hours work. Services are scheduled involuntarily for a specific time, if for medical reasons the doctor should not render the service at an earlier or later opportunity.
C. The fee that may be charged in respect of the rendering of a service not listed in this tariff of fees shall be based on the fee in respect of a comparable service.
D. Unless timely steps are taken to cancel an appointment for a consultation the relevant consultation fee shall be payable by the employee. In the case of a general practitioner "timely" shall mean two hours and in the case of a specialist 24 hours prior to the appointment. Each case shall however, be considered on merit and, if circumstances warrant, no fee shall be charged.
E. The appropriate fee may be charged for all pre-operative consultations with the exception of a routine pre-operative visit at the hospital.
F. Where applicable fees for administering injections and/or infusions may only be charged when done by the practitioner himself.
G.
(a) Unless otherwise stated, the fee in respect of an operation or procedure shall include normal after-care for a period not exceeding four months (after-care is excluded from pure diagnostic procedures during which no therapeutic procedures were performed).
(b) If the normal after-care is delegated to any other registered health professional and not completed by the surgeon, it shall be his/her own responsibility to arrange for this to be done without extra charge.
(c) When the care of post-operative treatment of a prolonged or specialised nature is required, such fee as may be agreed upon between the surgeon and the scheme or the patient (in case of a private account) may be charged.
(d) Normal after-care refers to an uncomplicated post-operative period not requiring any further incisions.
H. Items involving removal of lesions include follow-up treatment for four months.
I. Fees for all pathology investigations performed by members of other disciplines (where permissible): See section for Pathology. (Refer to M 0097).
J. In exceptional cases where the tariff fee is disproportionately low in relation to the actual services rendered by a medical practitioner, a higher fee may be negotiated. Conversely, if the fee is disproportionately high in relation to the actual services rendered, a lower fee than that in the tariff should be charged.
K. Save in exceptional cases the services of a specialist shall be available only on the recommendation of the attending general practitioner. Medical practitioners referring cases to other medical practitioners shall, if known to them, indicate in the reference that the patient was injured in an "accident" and this shall also apply in respect of specimens sent to pathologists.
L. If a procedure is performed at the time of an initial or subsequent consultation, the fee for the consultation plus the fee for the procedure is charged.
M. If such a procedure, planned at an initial or subsequent consultation, is performed at another time, the fee for the procedure only is charged.
N.
(a) No additional fee may be charged for a service for which the fee is indicated as "per consultation". Such services are regarded as part of the consultation performed at the time the condition is brought to the doctor's attention.
(b) Where a fee for any service is prescribed herein, the medical practitioner shall not be entitled to payment calculated on a basis of visits or examinations made where such calculation would result in the prescribed fee being exceeded.
(c) The number of consultations must be in direct relation to the seriousness of the injury and should more than 20 consultations be necessary, the Compensation Commissioner must be furnished, with a detailed motivation.
(d) A single fee for a consultation/visit shall be paid to a medical practitioner who gives a single treatment to an injured employee who thereafter passes to the permanent care of another medical practitioner, not being a partner or assistant of the first. The responsibility for furnishing the first medical report in such a case ordinarily rests with the second practitioner.
O.
(a) An employee should be hospitalised only if and for such a period his condition justifies full-time "medical aid".
(b) Occupational therapy/Physiotherapy. The same principles set out in modifier 0077 will apply when an employee is referred to a therapist.
(c) In the case of costly or prolonged medical services or procedures the medical practitioner shall first ascertain in writing from the Compensation Commissioner for what amount the Compensation Commissioner will accept responsibility in respect of such treatment.
P. Travelling fees
(a) Where, in cases of emergency, a practitioner was called out from his residence or rooms to an employees home or the hospital, travelling fees can be charged according to Section IV if he had, to travel more than 16 kilometres in total.
(b) If more than one employee would be attended to during the course of a trip, the full travelling expenses must be divided pro rata between the relevant employees.
(c) A practitioner is not entitled to charge for any travelling expenses or travelling time to his rooms.
(d) Where a practitioner's residence would be more than 8 kilometres away from a hospital, no travelling fees may be charged for services rendered at such hospitals, except in cases of emergency (services not voluntarily scheduled).
(e) Where a practitioner conducts an itinerant practice, he is not entitled to charge fees for travelling expenses except in cases of emergency (services not voluntarily scheduled).