Q&A: Changes to an inpatient-only procedure

Q. What processes should be followed if a procedure changes to inpatient-only during surgery?

A. When a procedure converts to an inpatient-only procedure during the surgery, the identification process may get a little more complex. The surgeon should confirm what surgery was actually performed in comparison to what was scheduled before he or she leaves the postoperative area. If there is a discrepancy, have a contingency plan ready so that the postoperative staff can contact a member of the coding team to assign a temporary code. If needed, the postoperative staff can obtain the order to admit at that time. Under current CMS guidance, the three-day payment window may apply in this scenario. The case should be held for billing purposes until a thorough post-discharge review can be completed.

For more information, see Inpatient-Only Procedures Training Handbook.

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