LSG Celle: Clinic cannot bill drug addiction syndrome for babies
If the mother-to-be smokes during pregnancy, the newborn is at risk of nicotine withdrawal. However, if the "nicotine baby" needs intensive medical treatment and respiration due to significant breathing and heart problems, the clinic must not charge for the treatment of a drug withdrawal syndrome, the State Social Court (LSG) Lower Saxony-Bremen decided in a judgment announced on July 9 (Az. : L 16 KR 43/16). Because according to hospital reimbursement law, tobacco is not considered a drug, according to the Celler Richter.
In the dispute was the accounting of the General Hospital (AKH) Celle for the treatment of a premature baby. The newborn was born on April 1, 2009 in the 30th week of pregnancy with a birth weight of only 1,060 grams.
Since the mother had smoked a lot during pregnancy, the child experienced symptoms of nicotine withdrawal. It had to be treated with intensive care medicine and ventilated due to considerable breathing and heart problems. The premature baby was only released on May 22, 2009.
The AKH billed a total of 39,205 euros for the treatment to the responsible health insurance company. The main diagnosis was a shortness of breath symptom of the newborn, as a secondary diagnosis a "withdrawal syndrome in the newborn when taking addictive medicines or drugs from the mother".
However, the health insurance company did not recognize the settlement of the secondary diagnosis after obtaining an MDK report. There was no drug withdrawal syndrome because tobacco and nicotine were not to be regarded as drugs. The health insurance company reduced the final bill by 6,796 euros.
The clinic's chief physician countered that nicotine caused addiction and caused withdrawal symptoms. Here the mother not only "smoked" her child. There were also typical withdrawal symptoms. The specialist society of children's hospitals and children's departments in Germany also mentioned alcohol and nicotine in addition to opiates, methadone and heroin as drug withdrawal symptoms in newborns.
The Lüneburg social court dismissed the AKH's complaint. According to the hospital remuneration law, tobacco is not assigned to drugs. In everyday language use, a smoker is just as little "drug addict" as a tobacco merchant is a "drug dealer".
The LSG confirmed this decision in its judgment of June 19, 2018. The clinic is not entitled to the invoice difference of 6,796 euros. According to the LSG, a distinction is made between drugs on the one hand and tobacco on the other in the regulations on how a clinic has to bill for individual diseases and symptoms. The billing provisions provide for codes for damage to the fetus and newborns from mother's tobacco consumption, the damage from mother's alcohol consumption and the damage to the newborn child from the use of addictive drugs or drugs by the mother. This shows that a distinction is made between tobacco, alcohol and drug use.
The billing of the "drug withdrawal syndrome" for tobacco use of the expectant mother is therefore ruled out. fle