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Paediatric Modifier Cheatsheet

Newborn & Paediatric consultation codes at a glance

CodeNameWhat it's for

0107

Newborn attendance

Exclusive attendance to baby at C-section, normal delivery, or a ward visit — once per patient. 0109, 0111, 0113, 0145, 0146, 0147 may not be added to the same line.

0109

Hospital follow-up visit

Patient in a ward or nursing facility, once per day only. Not with 0111, 0145, 0146, 0147, or ICU items (1204–1214). For a

healthy neonate

, use 0109 rather than 0111.

0111

Paediatric hospital follow-up

Excludes neonates — for paediatricians/paediatric cardiologists, once per day only. Not with 0109 or ICU items.

0113

Newborn attendance — emergency

Emergency attendance to a newborn at all hours, once per patient. 0107, 0109, 0111, 0145, 0146, 0147 may not be added to the same line.

0129

Prolonged face-to-face attendance

Add to 0192, 0175, 0164, or 0169 as appropriate, per 15-minute period, only if the service extends 10+ minutes into the next 15-minute period after the first 60 minutes.

0147

Unscheduled emergency consultation/visit

Away from the doctor's home or rooms, all hours. Add only to specific consultation items (0190–0192, 0173–0175, 0161–0164, 0166–0169, 0151–0153). Only one of 0145/0146/0147 may be charged, never combined.

0149

After-hours emergency consultation/visit

21:00–06:00 daily: +25% of the consultation/visit fee, only with the same specific consultation items as 0147.

0205

IV infusion, cut-down/push-in

Patients under 3 years. Chargeable once per 24 hours.

0206

IV infusion, push-in

Patients over 3 years. Chargeable once per 24 hours.

0209

Umbilical artery cannulation at birth

—

1227

Prolonged neonatal resuscitation

—

The neonatal / low-birth-weight surgical modifier

CodeNameRateRequirements

0019

Surgery on neonates & low-birth-weight infants

+50%surgeons · +50% anaesthetic time units for anaesthesiologists

Neonate (up to and including 28 days after birth) or low birth weight (under 2500g), under general anaesthesia.

Excludes circumcision.

Requires weight ≤ 2.5kg and must be applied to a surgical procedure code (verified elsewhere on this sheet against Nova's own Apply to behavior).

Building a paediatric surgical claim

Same principle as any surgical claim in Nova — 0019 takes the place 0018 (BMI) holds for an adult claim.

  1. Procedure line(s) - Add the paediatric surgical procedure(s) first.
  2. If neonate code 0019(Neonate / low-birth-weight addition) - Directly after the procedure it applies to — must be on the invoice before the assistant fee modifier, or it won't appear in that modifier's Apply to list.
  3. If emergency 0011(Surgeon's emergency time) - One line for the surgeon's emergency time.
  4. If assistant present 0009 or 0008(Assistant fee) - Added last, applied to the procedure and 0019 — not to 0011.
  5. If emergency + assistant 0011(Assistant's emergency time) - A separate line for the assisting doctor, added after 0009/0008.

Critical rules

  1. 0019 requires weight ≤ 2.5kg and a surgical procedure code. It excludes circumcision specifically, and must be applied to a procedure line, not a consultation or flat-rate item.
  2. 0107, 0109, 0111, and 0113 are mutually exclusive on the same visit. Adding more than one of these newborn/follow-up attendance codes together is incorrect — each covers a different scenario (delivery attendance, ward follow-up, paediatric-specific follow-up, or emergency attendance).
  3. Only one of 0145, 0146, or 0147 may be charged per visit. These are alternative emergency-consultation codes, not combinable.
  4. Billing order matters even among consultation modifiers. Example order: 0175, then 0147, then 0129 — do not insert 0129 between 0175 and 0147.
  5. Newborn registration can take up to a month. Claims for babies may need authorisation updated with the baby's own details once registration completes (name, surname, ID). Until then, a claim may need to be held or resubmitted.
  6. Discovery PGP (Paediatric Governance Project) has its own published rates. If the scheme is Discovery and the plan falls under PGP, refer to Discovery's own published PGP documents rather than the standard tariff.


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