I was asked by a payer to review a claim submitted by a hospital. The hospital billed ICD 10 PCS code ODH673Z. This code is listed as an operating room procedure in CMS Appendix E, however, it was performed at the bedside and there is no operative report. I am assuming that an "operating room procedure" must be performed in the operating room but I cannot find a guideline that states this. Can someone please offer some guidance on procedures performed at the bedside that are listed as operating room procedures in Appendix E. Thanks
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Wiki ICD 10 PCS Operating Room Procedure
- Thread starter SLW1501
- Start date
mitchellde
True Blue
I am assuming this was a feeding tube. These are frequently performed at the bedside. There should be a procedure note but it may not be in the form of an operative note. Look at the physician note for that visit day.
The way it is coded it mapped to DRG 853 INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC. The code is listed in Appendix E as an operating room procedure. My question is whether it can be considered an OR procedure for DRG assignment since it was not done in the OR and does not have an operative report. This is not the first time this situation has come up and I cannot find a guideline that clarifies it.