Institut national d'assurance maladie-invalidité. - Règles interprétatives de la nomenclature des prestations de santé Sur proposition du Conseil technique médical du 14 mars 2023 et en application
Institut national d'assurance maladie-invalidité. - Règles interprétatives de la nomenclature des prestations de santé
Sur proposition du Conseil technique médical du 14 mars 2023 et en application de l'article 22, 4° bis, de la loi relative à l'assurance obligatoire soins de santé et indemnités, coordonnée le 14 juillet 1994, le Comité de l'assurance soins de santé a pris le 27 mars 2023 les décisions suivantes :
Règles interprétatives relatives aux prestations de l'article 25 de la nomenclature des prestations de santé :
La règle interprétative 04 est abrogée.
REGLE INTERPRETATIVE 07
QUESTION
Qu'advient-il de l'immunisation lorsqu'une nouvelle intervention succède à une autre pendant la même période d'hospitalisation ?
Qu'advient-il de l'immunisation lorsque l'hospitalisation est interrompue ou que le bénéficiaire est transféré dans un autre service ?
REPONSE
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Lorsque pendant une même période d'hospitalisation, plusieurs interventions thérapeutiques chirurgicales ou orthopédiques ou prestations obstétricales se succèdent, chaque nouvelle intervention met fin à la période d'immunisation précédente et ouvre une nouvelle période d'immunisation de cinq jours.
Toutefois, les interventions chirurgicales lourdes, visées à l'article 25, § 2, a), 2°, 3e alinéa, de la nomenclature des prestations de santé, n'entraînent pas l'immunisation des honoraires de surveillance pendant cinq jours. (Cette règle d'exception reste d'application lorsqu'une intervention chirurgicale non visée à l'article 25, § 2, a), 2°, 3e alinéa, de la nomenclature précède ou suit une intervention de chirurgie lourde).
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Il n'est pas mis fin à la période d'immunisation lorsque le bénéficiaire rentre après une interruption de l'hospitalisation de moins de 4 jours (moins de 31 jours en service K, A, T, Sp-chronique, G et Tf) et dès lors, les jours d'absence sont pris en considération pour le calcul du...
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