Coding, Classification and Reimbursement

Cancelled Inpatient Procedure

  • 1.  Cancelled Inpatient Procedure

    Posted 12-27-2018 14:18

    How are others interpreting this PCS Guideline B3.3 ?  If a procedure is cancelled due to A Fib, say a resection of the lung, but the cancellation is after IV ringer's lactate and one dose of fentanyl given (anesthesia start) – would an inspection of the lung be appropriate?  The example provided seems to infer some portion of the total procedure must be initiated in order to use inspection. 

     

    Discontinued or incomplete procedures

    B3.3

    If the intended procedure is discontinued or otherwise not completed, code the procedure to the root operation performed. If a procedure is discontinued before any other root operation is performed, code the root operation Inspection of the body part or anatomical region inspected.

    Example: A planned aortic valve replacement procedure is discontinued after the initial thoracotomy and before any incision is made in the heart muscle, when the patient becomes hemodynamically unstable. This procedure is coded as an open Inspection of the mediastinum.

     

     

     

    Cindy Greathouse, MHA, RHIA, CCS

    Manager, Inpatient Clinical Coding

    Maine Health | Maine Medical Center

    Revenue Cycle – CBO Coding

    Office: 207-396-6815 Cell: 207-713-4459

    cgreathous@mmc.org

     

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  • 2.  RE: Cancelled Inpatient Procedure

    Posted 12-28-2018 02:53
    Dear Cynthia,

    This guideline is not same as CPT coding. There should be some type of approach started (Percutaneous/Open) for the planned procedure, after that circumstances stopped the procedure to proceed further then we supposed to report inspection. But in your case Inspection root operation is not appropriate to code. There is only initiation of anesthesia was happened so this is not even meeting the definition of inspection root operation. Hence we should not report any procedure.
    Hope this helps!!!

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    Sathya Mohanasundaram
    Senior Medical Coder
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  • 3.  RE: Cancelled Inpatient Procedure

    Posted 12-28-2018 08:52
    I agree with Sathya.  Definitions of modifier 73/74 are not applicable to PCS coding.

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    Sheila Goethel
    Coding Services Senior Manager
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  • 4.  RE: Cancelled Inpatient Procedure

    Posted 12-28-2018 10:44
    I don't see how you could code Inspection of Lung, because nothing had been inserted, no surgical incision, etc. In the example, they had done a thoracotomy. In your case, they had just administered an initial sedative.