4.5.37.3 Day surgery
Day surgery patients are patients who are admitted and discharged on the same day and where a surgical procedure has been performed.
- Where a patient subsequently requires overnight or longer accommodation medical practitioner certification is required which includes:
- contemporaneous ICD-AM codes for the relevant injury or condition being treated and
- the medical condition or special circumstances warranting overnight care
- Theatre procedures should be reimbursed at the appropriate theatre band
- There are four day accommodation bands which apply to the day surgery procedures. Accommodation bands for day surgery cases are paid depending on the type of anaesthetic used during the surgical procedures and the time taken in the operating theatre according to the following rules:
- Band 1 – is payable where a procedure is performed with no anaesthetic
- Band 2 – is payable where procedures are carried out under local anaesthetic, without sedation
- Band 3 – is payable where procedures are carried out under general or regional anaesthetic or IV sedation and the theatre time is less than one hour
- Band 4 – is payable where procedures are carried out under general or regional anaesthesia or intravenous sedation and actual theatre time that is taken s more than one hour.
- Non-Band Specific classes of MBS Medicare Benefits Schedule items will qualify for day only accommodation bands depending on anaesthetic and theatre times. In the absence of a theatre time WorkSafe can only pay band 1 day only accommodation charges
- 'Day only’ Accommodation Bands are not payable for DoHA Type C Professional Attention MBS items unless medical certification is provided.