Q&A: Billing a cancelled inpatient-only procedure

December 11, 2017
Medicare Web

Q. Can a facility bill a cancelled inpatient-only procedure (modifier –74 criteria) as an observation/outpatient bill/patient type (Type of Bill 131) or does the patient type/status remain as inpatient (Type of Bill 111)?

To clarify, one of our physicians wrote inpatient order for intended inpatient-only procedure, but the procedure was cancelled based on modifier –74 criteria and an outpatient order was written while patient still in hospital (not yet discharged). The patient type was changed to observation/outpatient. Our outpatient Type of Bill 131 will reflect a cancelled inpatient only procedure. Is this acceptable?

A. An inpatient-only procedure is statutorily protected and should only be performed on inpatient basis, even if the procedure was cancelled after the induction of anesthesia and/or procedure is started. In the scenario described, the case should remain inpatient status and should be coded/billed accordingly. The case should not be changed back to outpatient status. If an inpatient-only procedure is billed on Type of Bill 131, the claim will not be paid, regardless of the presence of modifier –74.


This question was answered by Debbie Mackaman, RHIA, CPCO, CCDS, regulatory specialist for HCPro, an H3.Group brand, in Middleton, Massachusetts.

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