3.1 There are some cases where
the newborn stays in the mother’s room and does not incur nursery
charges. It would not be appropriate to pay such cases under DRG
391, Normal Newborn, because the basic service of that DRG is nursery
charges. Therefore, the newborn services in such cases shall be
exempt from the DRG system and paid based on billed charges. In
order to pay such services based on billed charges, the following
conditions must be met.
3.1.1 The services,
if they were paid under the DRG-based payment system, would group
only into DRG 391.
3.1.2 There
can be no nursery/room charges for the newborn.
3.1.3 The billed charges for the
newborn (pharmacy, supplies, etc.) must be included on the mother’s
claim.