Category: | 15 Major Procedure (pre-operative period: 0 days, post-operative period: 7 days) |
---|---|
Base rate: | $706.06 |
Type | Code | # of calls | Explicit | Action | Amount |
---|---|---|---|---|---|
BMI | BMIANE | Yes | Increase By | 25% | |
BMI | BMIANT | Yes | Increase By | 25% | |
BMI | BMIPRO | Yes | Increase By | 25% | |
ROLE | ANE | Yes | Replace Base | $188.63 | |
ROLE | ANEST | Yes | Replace Base | $18.70 | |
ROLE | SA | Yes | Replace Base | $148.42 | |
ANU | ANU | 1 | For Each Call Pay Base At | 100% | |
ANU | ANU | 2 - 150 | For Each Call Increase By | $18.70 | |
SAU | SAU | 1 | For Each Call Pay Base At | 100% | |
SAU | SAU | 2 - 33 | For Each Call Increase By | $37.13 | |
SURC | EV | Yes | Increase By | $48.82 | |
SURC | NTAM | Yes | Increase By | $117.12 | |
SURC | NTPM | Yes | Increase By | $117.12 | |
SURC | WK | Yes | Increase By | $48.82 |
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.
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 |
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.
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.
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