Revised Billing Instructions for Never Events
Revised instructions on the billing of surgical never events for inpatients were included in Transmittal 1815, CR 6634 (see page 72) which provided information on the 2010 IPPS changes.
Hospitals are still required to submit two inpatient claims when both a surgical error and covered services are being reported: one claim for the covered services (11X bill type) and a no-pay claim for the non-covered services related to the surgical error (110 bill type). Both claims will have the same Statement Covers Period.
For discharges prior to October 1, 2009, providers should indicate one of the following two-digit codes in the Remarks field on the inpatient claim for the non-covered services.
- MX: wrong surgery on patient
- MY: surgery on wrong body part
- MZ: surgery on wrong patient
The revised instructions are for discharges on or after October 1, 2009. Instead of using the above two-digit codes in the remarks field, providers must enter one of the following ICD-9-CM diagnosis codes in diagnosis position 2-9. Although these are E codes, they should not be reported in the E-code field.
- E876.5 – Performance of wrong operation (procedure) on correct patient
- E876.6 – Performance of operation (procedure) on patient not scheduled for surgery
- E876.7 – Performance of correct operation (procedure) on wrong side/body part