Hospital Care – Billing for Obstetrical Patients

Prior to and Including the Day of Delivery

Tariff 8520 (Hospital Care – per day) is not normally payable for hospital stays prior to and including the day of delivery, regardless of the delivery tariff claimed, except as set out in Rule of Application 33 (i), which states:

Serious complications that require hospitalization prior to delivery are not included in the benefits provided for obstetrical care. Such complications will be paid for at the scheduled benefits if substantiated by Special Report.

Post-Delivery

When a routine vaginal delivery is performed, and tariff 4822 (Routine vaginal delivery without manual removal of placenta, with or without repair of minor lacerations) is claimed, tariff 8520 is payable for each day of the patient’s hospital stay from the day AFTER delivery up to and including the day of discharge.

When a caesarean section is performed, and tariff 4800 (Caesarean section with or without sterilization) or tariff 4803 (Caesarean hysterectomy) is claimed, the benefit for the procedure includes three weeks postoperative care and, therefore, tariff 8520 may not be claimed except as set out in Rule of Application 23, which states:

Where the patient’s condition requires prolonged hospital care in iteself, and where an incidental surgical service is interposed, appropriate hospital care benefits may be claimed but such claims must be accompanied by a Special Report.

Additional Information – Pre-natal/Post-natal Visits and Special Calls

  • Tariff 8401 (Pre-natal visit) and tariff 8402 (Post-natal visit) may not be claimed for in-hospital patients.
  • Provided the other elements of a special call are met, special call Tariff 8566 may be claimed in the following circumstances:
    • By the physician who performs the delivery.
    • By the physician who performs the emergency caesarean section.
    • By a physician who attends to assess a patient, but does not perform the delivery/caesarean section
  • A special Call may not be claimed for elective caesarian sections.
Questions?

Ian Foster
ifoster@docsmb.org
(204) 985-5854

 

Updated: November 2016