Q&A: Coding for a canceled inpatient-only procedure

September 9, 2019
Medicare Web

Q: How should we handle canceled inpatient-only procedures? Are these are still coded to the full intended procedure under OPPS and modified with a -73 or -74 modifier? Most of these cases result in changed orders to outpatient due to the patient being discharged the same day. Can the original inpatient order be used?

A: You must follow the applicable coding guidelines for canceled inpatient-only procedures. If an inpatient order was written, you can't just decide it's an outpatient procedure because the procedure was canceled and it is on the inpatient-only list. It depends when the procedure is aborted: pre-anesthesia or post-anesthesia. Check the coding guidelines for exact procedures and billing status.

For more information, see the April 26 webinar Mastering the Inpatient-Only List: Strategies to Ensure Compliance and Avoid Denials.”