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"Inpatient Only" procedure discontinued after anesthesia

  1. Default "Inpatient Only" procedure discontinued after anesthesia
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    Does anyone know a CMS instruction addressing how to bill (OPPS) for a procedure discontinued (carotid thromboendarterectomy) after anesthesia administered, facial vein ligated and transected but physician unable to visualize the internal carotid and the procedure was terminated. Will Medicare accept an inpatient only code on an outpatient bill.

  2. Default
    My understanding is that Medicare will cover inpatient only procedures done in an outpatient setting only if the procedure was done in an emergency situation. You would append modifier CA--PROCEDURE PAYABLE ONLY IN THE INPATIENT SETTING WHEN PERFORMED EMERGENTLY ON AN OUTPATIENT WHO EXPIRES PRIOR TO ADMISSION. Otherwise, the hospital has to eat the cost.

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