Starting today, October 5, hospitals must submit two claims to Medicare when an erroneous surgery is reported in addition to covered services or procedures that are provided during the same stay. Erroneous surgeries include procedures involving the wrong patient, procedure, or body part, which are no-pay claims under a national coverage decision implemented by the Centers for Medicare & Medicaid Services (CMS) in January.
The CMS previously issued CR 6405 to provide instruction to hospitals on how to bill erroneous surgeries. It explained that, for inpatient claims, hospitals are required to submit a no-pay claim when the erroneous surgery is reported. CMS has made additional changes to the coding instructions. The billing changes and nonpayment policy are effective for claims submitted Oct. 5 or later for services delivered after Jan. 15, 2009. Further information is provided in the CMS newsletter, MLN Matters, No. MM6634.
