Preoperative Care – Can you claim tariff 8520 hospital care?

Rule of Application 24 – Preoperative Care reads:

Preoperative Care of normal duration after admission to hospital for Elective surgery is included in the benefits listed for the surgical service. Where medical complications/conditions result in unduly long preoperative stay, claims for daily visits up to the time of surgery may be made by Special Report which must describe the complication, condition and treatment required to justify the delay in the surgery.

Billing Notes:

As stated above, you are not eligible to claim preoperative care that is of normal duration after admission for Elective Surgery.

Tariff 8520 Hospital Care-per day may be claimed:

  • For care prior to non-elective surgery by the physician of record;
  • For care for elective surgery when medical complications/conditions result in unduly long preoperative stay. These claims will require a Special Report that describes the complication, condition and treatment required to justify the delay in surgery.

Unduly long has not been defined by the parties and will be determined on a case-by-case basis.

For further information you are encouraged to review Hospital Care – Tariff 8520

Questions?

Roger Jamieson
rjamieson@docsmb.org
(204) 985-5849

 

 

Updated: May 2013