Rule of Application 24 – Preoperative Care states:

“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 an unduly long preoperative stay, make claims for daily visits up to the time of surgery via a Special Report, which must include descriptions of the complication, condition and treatment required to justify the surgery’s delay.

Billing Notes

As stated above, you are generally not eligible to claim for preoperative care with Elective Surgery admission. Claim Tariff 8520 — Hospital Care per day for care provided in these circumstances:

• Prior to non-elective surgery by the physician of record; and
• For elective surgery when medical complications/​conditions require hospitalization with an unduly long preoperative stay.

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