Governing Rules:

• 6.8.1

  HSCs with a designated category code of 1 and 15 include related post-operative services and those with a designated category code of 3, 4, 6 and 14 include both related pre-operative and post-operative services.

  1. a consultation benefit may be claimed up to and including the day of surgery.
  2. pre-operative hospital care may be claimed by the physician who performs the surgery if information is submitted to show that conservative treatment was attempted before surgery was performed.
  3. benefits may be claimed as applicable for complications occurring during or following post-operative time periods.
  4. Deleted
  5. HSC 03.04R may be claimed in the pre-operative time frame when all conditions in the notes have been met.

  The following chart gives the pre-operative and post-operative periods.

  Category	Pre-operative	Post-operative
  1	0 - Days	14 - Days
  3	7 - Days	7 - Days
  4	7 - Days	14 - Days
  6	14 - Days	14 - Days
  14	30 - Days	14 - Days
  15	0 - Days	7 - Days

• 6.14.2

  Notwithstanding GR 6.14.1, the same physician who claims HSC 87.98B may also claim a surgical assist for cesarean section on the same patient on the same day. The conditions indicated under HSC 87.98B must also be met.

• 6.14.3

  Notwithstanding GR 6.14.1, in a rural location, a physician may claim both HSC 87.98B and an anesthetic service on the same day when:

  1. he or she must call in another physician to complete the delivery and
  2. he or she provides an anesthetic service for the delivery and
  3. the conditions indicated under HSC 87.98B have been met.
• 8.1.4

  The delivery benefit includes payment to the attending physician for procedures such as surgical induction, episiotomy, repair of episiotomy or non-extensive lacerations (first or second degree as defined below), and ordinary immediate care of the newborn.

  First degree is defined as a superficial laceration of the vaginal mucosa or perineal body which does not require suturing.

  Second degree is defined as a laceration involving the vaginal mucosa and/or perineal skin and deeper subcutaneous tissue and requiring suturing.

  Third degree is defined as an extension of the laceration which involves any part of the capsule or anal sphincter muscle or deep vaginal sidewall laceration.

  Fourth degree is defined as extensive including involvement of the rectal mucosa.

• 8.1.5

  When a delivery occurs within 24 hours of admission, the delivery benefit includes the hospital admission (HSC 03.04C) or hospital visit (03.03D). Post-partum hospital visits, by the same or different physician, for the period of one week after the delivery, and ordinary immediate care of the newborn are also included. When there is a life threatening situation which requires neonatal resuscitation, HSC 13.99F may be claimed as well.