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MP 10.01.01

Attempted Surgery


Medical Policy
Section
Administrative
Original Policy Date
11/30/96
Last Review Status/Date
Reviewed by consensus/3:2003
Issue
3:2003
Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.


Description

Attempted surgery refers to a surgical procedure in which the planned procedure could not be accomplished or performed. An example would be when suspected disease in an abdominal organ was not present and only the exploratory laparotomy was performed, or if the patient’s cardiorespiratory status deteriorated intraoperatively requiring discontinuation of the procedure.


Policy

Attempted surgery should be considered eligible for coverage and based on the procedure that was actually performed and not the intended procedure.


Policy Guidelines

No applicable information


Benefit Application

BlueCard/National Account Issues

Plans vary reimbursement at cost of the full procedure or cost for half of the procedure.


Rationale

The information compiled for this policy was a combination of standard billing practices, Plan policies, and claims experience.

 

Codes

Number

Description

CPT 

No Code 

ICD-9 Procedure 

No Code 

ICD-9 Diagnosis 

V64.1 

Procedure canceled due to contraindication 

 

V64.3 

Procedure canceled due to other reasons 

HCPCS 

No Code 

Type of Service 

Administrative 

Place of Service 

Inpatient
 
Outpatient
 


Index

Attempted surgery
Surgery, attempted


Policy History

 

Date Action Reason
11/30/96 Add to Administrative section New policy
4/15/02 Replace policy Policy reviewed without literature review; new review date only
10/9/03 Replace policy Policy reviewed by consensus without literature review; no changes in policy; no further review scheduled


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