New Judgment Tobacco is not considered a drug

LSG Celle: Clinic may not bill for drug withdrawal syndrome in baby

If the expectant mother smokes during pregnancy, the newborn is threatened with nicotine withdrawal. If the "nicotine baby" must undergo intensive medical care and be ventilated because of considerable respiratory and cardiac problems, the clinic may not charge for the treatment of a drug withdrawal syndrome, the Landessozialgericht (LSG) of Lower Saxony-Bremen ruled in a ruling issued on 9 July (Az. : L 16 KR 43/16). According to the Hospital Remuneration Act, tobacco is not considered a drug, according to the Celle judges.

In the dispute was the settlement 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 had symptoms of nicotine withdrawal. It had to be treated intensively and ventilated because of considerable respiratory and heart problems. It was not until May 22, 2009 that the premature baby was released.

For the treatment, the AKH charged the responsible health insurance company a total of 39,205 euros. The main diagnosis was a neonatal respiratory distress syndrome, as a secondary diagnosis a "neonatal withdrawal syndrome with the use of maternal dependency-producing drugs or drugs".

But the health insurance recognized after obtaining a MDK report, the billing of secondary diagnosis not. There was no drug withdrawal syndrome, since tobacco and nicotine should not be considered drugs. The health insurance reduced the final bill by 6,796 euros.

The chief physician of the clinic countered that nicotine creates a dependency and causes withdrawal symptoms. Here, the mother not only "dived in" her child. It also had a typical withdrawal symptoms. The 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 Social Court Lüneburg dismissed the action of the AKH. According to the hospital reimbursement law, tobacco is not assigned to drugs. In everyday language use, moreover, a smoker is just as little "drug-addicted" as a tobacconist is a "drug dealer".

The LSG confirmed this decision in its judgment of 19 June 2018. The clinic is not entitled to the invoice difference of 6,796 euros. In the regulations, how a clinic has to settle single illnesses and symptoms, differentiated between drugs on the one hand and tobacco on the other hand, so the LSG. For example, the billing rules provide for codes of fetal and neonatal fetal harm from mother's tobacco use, maternal alcohol abuse, and neonatal harm from the onset of dependency-producing drugs or drugs by the mother. This shows that a distinction is made between tobacco, alcohol and drug use.

The accounting of the "drug withdrawal syndrome" in the case of tobacco consumption of the expectant mother therefore excludes. fle