CMS Issues Information About Never Events

Effective Jan. 15, 2009, the Centers for Medicare and Medicaid Services (CMS) does not cover surgical or invasive procedures necessary to treat medical conditions when the practitioner erroneously performs:

• A different procedure altogether;
• The correct procedure but on the wrong body part; or
• The correct procedure but on the wrong patient.

For inpatient claims, hospitals are required to submit a no-pay claim when the erroneous procedure is reported.  Two claims should be submitted when there are covered services/procedures provided during the same stay as the erroneous surgery but unrelated to the erroneous surgery.  For outpatient and practitioner claims, providers are required to append the applicable HCPCS modifiers to all lines related to the erroneous procedure.

CMS has issued additional information about “never event” scenarios.