How Do You Do Billing for Cancelled Surgery? Comprehensive Guide

In the realm of healthcare administration, one of the critical aspects that often arises is the billing for cancelled surgery. This comprehensive guide aims to elucidate the intricacies of billing for cancelled surgeries, ensuring patients and healthcare providers are well-informed and satisfied with the process.

Medical procedures and surgeries are meticulously planned, but unforeseen circumstances can necessitate the cancellation of a scheduled surgery. These reasons can range from a patient’s sudden health deterioration, unavailability of necessary equipment, or scheduling conflicts.

The Billing Process for Cancelled Surgeries

Initial Assessment

Once the surgery is cancelled, our dedicated administrative team thoroughly assesses the situation. This involves reviewing the patient’s medical history, the reasons for cancellation, and any preoperative expenses that have already been incurred.

Insurance Verification

Our team promptly verifies the insurance details for patients with insurance coverage to understand how much-cancelled surgery expenses can be covered. This step ensures that patients are billed accurately based on their insurance policy.

Cost Calculation

To ensure transparency, we meticulously calculate the costs of the cancelled surgery. This includes fees related to preoperative tests, consultations, and any other preparatory steps undertaken.

Patient Notification

Once the assessment and cost calculation is complete, we notify the patient about the financial implications of the cancelled surgery. Our team provides a breakdown of the costs, applicable insurance coverage, and the patient’s responsibility.

Flexibility and Support

At [Your Medical Center Name], we recognise that unexpected medical events can be emotionally and financially distressing. Our billing department is committed to offering flexible payment options and supporting patients in managing their bills.

Ensuring Patient Satisfaction and Trust

• Transparent Communication

Our priority is building trust with our patients. Transparent communication throughout the billing process fosters understanding and minimises potential confusion. Patients appreciate being informed about the intricacies of the billing process.

• Dedicated Support Team

Patients can contact this team for clarifications, assistance with insurance claims, and guidance on managing their financial responsibilities.

• Feedback and Improvement

We value feedback from our patients and continuously strive to improve our processes. Any feedback received about the billing process for cancelled surgeries is thoroughly reviewed, and adjustments are made to enhance the overall experience.

Cancelled procedure coding guidelines

Cancelled procedure coding guidelines provide structured instructions for accurately documenting and coding procedures that have been cancelled. These guidelines are crucial in healthcare to maintain accurate medical records and ensure proper reimbursement.

It’s essential to adhere to specific coding conventions when coding for cancelled procedures. Coders should use the appropriate CPT (Current Procedural Terminology) codes that reflect the intended design. However, when a system is cancelled before it’s initiated, coders should not assign a CPT code.

In cases where a procedure was started but not completed due to patient complications or other factors, coders should assign a CPT code representing the work completed up to that point. Additionally, a modifier should be applied to indicate the incomplete nature of the procedure.

If a procedure is cancelled after anaesthesia induction but before the surgical procedure begins, coders should use specific codes to indicate this sequence. Similarly, if a policy is cancelled due to extenuating circumstances, coders should document the reasons for cancellation and use appropriate codes.

10 Code For The Cancelled Procedure 

In the ICD-10 coding system, there isn’t a specific code designated for cancelled procedures. ICD-10 principles primarily focus on diagnosing medical conditions and describing patient encounters rather than indicating procedural status. Therefore, cancelled practices do not have a dedicated ICD-10 code. Instead, documentation about the cancelled procedure is typically captured in the medical record but not represented through an ICD-10 code. It’s essential to rely on other coding systems, such as CPT (Current Procedural Terminology) codes, to accurately document and communicate the cancelled procedure’s details.

What are the billing requirements if a patient cancels surgery?

When a patient cancels a surgery, specific billing requirements come into play to ensure accurate financial transactions and transparent communication. Here are the critical billing requirements in such cases:

• Timely Notification: The patient should notify the medical facility as soon as possible about the cancellation. This allows the billing department to halt any further financial processing related to the surgery.
  
• Documentation: Proper documentation of the cancellation reason and the patient’s decision is essential.
  
• Charges Review: The billing team reviews any charges incurred up to the point of cancellation. This includes preoperative tests, consultations, and any preparatory steps taken. The final billing statement should consist of only legitimate charges related to services provided.
  
• Insurance Verification: If the patient has insurance coverage, the billing department verifies the coverage details. This helps accurately determine the patient’s financial responsibility and potential insurance reimbursement.
  
• Calculation of Costs: The costs associated with the cancelled surgery are calculated accurately. This involves tallying up the charges for the services rendered before cancellation.
  
• Patient Notification: The patient is informed about the financial implications of the cancelled surgery. This includes a breakdown of charges, any applicable insurance coverage, and the patient’s responsibility.
• Refund or Adjustment: Refunds or adjustments may be required depending on the scenario. For instance, if the patient had made a prepayment, this amount might need to be refunded.
  
• Communication: Clear communication is vital throughout the process. The billing team should be available to address any patient queries or concerns related to the billing adjustments.
  
• Documentation of Communication: Any communication with the patient, including phone calls, emails, or letters, should be documented in the patient’s record to maintain a clear description of the billing process.
  
• Record Keeping: All billing documents related to the cancelled surgery should be kept in the patient’s file for accurate record keeping and potential audits.
  

How do you bill for unsuccessful procedure coding guidelines?

Billing for unsuccessful procedures involves specific coding guidelines to accurately reflect the medical services and ensure proper reimbursement. Here’s a concise guide on how to bill for unsuccessful procedures:

• Correct CPT Code: Choose the appropriate Current Procedural Terminology (CPT) code corresponding to the attempted procedure. Use the code representing the specific procedure and the work completed, even if the process was unsuccessful.
  
• Modifier Usage: Apply a relevant modifier to indicate the unsuccessful procedure. Commonly used modifiers include “-52” (Reduced Services) and “-73” (Discontinued Outpatient Procedure). These modifiers tell the payer that the procedure was initiated but still needs to be completed.
  
• Documentation: Thoroughly document the procedure’s start, the work performed, and the reason for discontinuation. Accurate documentation ensures transparency and supports proper reimbursement.
  
• Modifier Descriptions: Ensure that the modifier used accurately reflects the situation. Modifier “-52” indicates reduced services due to the procedure’s partial completion, while modifier “-73” indicates discontinued operation due to extenuating circumstances.
  
• Clear Communication: If the payer requests additional information about the unsuccessful procedure, provide concise and accurate details in line with medical documentation.
• Insurance Verification: Verify the patient’s insurance coverage to determine how the unsuccessful procedure will be covered or reimbursed. Some insurance plans might have specific guidelines for handling these scenarios.
  
• Patient Communication: Communicate with the patient about the billing and financial implications of the unsuccessful procedure. Provide a clear breakdown of the charges and any potential adjustments.
  
• Appeals: In cases where the payer disputes reimbursement due to the unsuccessful nature of the procedure, be prepared to provide thorough documentation and explanation to support your billing claim.
  
• Coding Accuracy: Ensure that the CPT code chosen accurately represents the procedure attempted. Using an incorrect code can lead to denied claims and complications in reimbursement.
  
• Medical Necessity: Justify the medical necessity of the attempted procedure in the documentation. This can play a role in supporting the claim during the billing process.
  

Can a patient cancel surgery?

Yes, a patient can indeed cancel a surgery. Patients have the right to decide about their medical care, including whether to proceed with a scheduled surgical procedure. There can be various reasons why a patient might choose to cancel a surgery:

• Change in Health Status: Patients’ health conditions can change unexpectedly, making them reconsider or delay a scheduled surgery.
• Personal Reasons: Personal circumstances, family emergencies, or work-related issues might lead a patient to cancel the surgery.
• Second Opinions: After seeking a second opinion, a patient might cancel surgery if an alternative treatment plan is recommended.
• Financial Concerns: High medical costs or unexpected financial burdens might prompt patients to cancel the surgery.
• Fear and Anxiety: Anxiety about the surgical procedure, anaesthesia, or potential outcomes can cause patients to cancel surgeries.
• Lack of Readiness: Patients might feel unprepared for the procedure due to inadequate information or emotional readiness.
• Unforeseen Events: Unexpected events, such as illness in the family or natural disasters, can lead to surgery cancellations.
• Miscommunication: Miscommunication or misunderstanding about the procedure, risks, or expected outcomes could prompt a patient to cancel.

What is meant by the discontinued procedure modifier?

The “discontinued procedure modifier” is used in medical coding to indicate that a medical procedure was initiated but not completed as planned. It helps convey to healthcare payers and other medical professionals that a process was started but had to be stopped before its intended completion for various reasons. This modifier provides essential information about the nature of the procedure and its outcome. In the context of medical coding, it is designated as modifier “-73.”

The “discontinued procedure modifier” is crucial for accurate billing and documentation. It signifies that while a procedure was initiated, it could not be carried out as intended due to unexpected factors such as patient complications, technical difficulties, or extenuating circumstances. This modifier aids in proper reimbursement from insurance companies, as it communicates that the healthcare provider invested resources and effort into the procedure, even if it wasn’t fully completed.

The “discontinued procedure modifier” helps healthcare professionals communicate medical procedures’ complexity and outcomes, ensuring accurate representation in medical records and billing documents.

Conclusion

Navigating the complexities of billing for cancelled surgeries requires compassionate communication and meticulous financial assessment. We at U Control Billing understand the importance of transparent communication and efficient billing procedures.

FAQS

What happens if you cancel surgery the day before?

If you decide to cancel a surgery the day before it is scheduled, several important considerations come into play. The exact procedures and consequences can vary based on the healthcare facility’s policies, the type of surgery, and the reasons for cancellation. Here’s a general overview of what might happen:

• Communication with the Healthcare Provider: You must inform your healthcare provider or surgeon about your decision to cancel the surgery as soon as possible. This allows them to adjust their schedule and allocate resources accordingly.
• Rescheduling: Depending on the reason for cancellation and the availability of the surgical team and facilities, your surgery might be rescheduled for later. The healthcare provider will work with you to find a suitable time.
• Administrative Procedures: The healthcare facility’s staff will update your medical records to reflect the cancellation. This documentation is essential for accurate record-keeping and billing.
• Financial Considerations: The timing of the cancellation can influence financial aspects. If you have made prepayments or have insurance coverage, the facility’s billing department will provide information about potential refunds or adjustments.
• Preparation and Restrictions: If the surgery requires specific practices, such as fasting or medication adjustments, you will receive guidance on proceeding, especially if the rescheduled date is not too far.
• Patient Health: In some cases, a decision to cancel the surgery might be influenced by changes in your health. Emotional and Psychological Support: Surgery cancellations can evoke emotions such as stress or disappointment. Healthcare providers and support staff are there to address your concerns and provide emotional support.
• Documentation: Be prepared to explain the cancellation, as this information may be documented in your medical records. This documentation is essential for your ongoing care and any potential future procedures.
  

How do you code a Cancelled surgery?

Coding a cancelled surgery involves using specific codes to accurately document the situation in medical records and billing. There is no dedicated code for cancelled surgeries in the Current Needs to Beedural Terminology (CPT) coding system. Instead, you would follow specific guidelines to represent the situation appropriately. Here’s how to code a cancelled surgery:

What happens if my surgery is cancelled?

If your surgery is cancelled, the healthcare facility will reschedule the procedure based on availability and health status. Financial adjustments may be made, and your healthcare provider will guide necessary preparations or precautions.

How do you code a cancelled procedure in ICD 10?

The ICD-10 coding system has no specific code for a cancelled procedure. ICD-10 focuses on diagnosis and patient encounters, so cancelled procedures are documented in other ways, such as through CPT codes with appropriate modifiers.

Can you bill for a failed procedure? 

Yes, you can bill for a failed procedure. In cases where a medical operation was attempted but not completed due to unforeseen circumstances, you can bill for the work and resources invested up to the point of discontinuation using the appropriate CPT code. 

https://www.icd10data.com/ICD10CM/Codes

Touseef Riaz

A couple of years ago, I executed the effective plan of creating a Medical billing and Coding company named U Control Billing. The company aims to bring revolutionary advancements to foster medical billing and coding revenues. As an official member of HIA-LI and MGMA, I feel honored in providing networking opportunities, problem-solving, and improving the revenue management cycle.