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Policy No: 106

Originally created: 04/01/2009

Section: Administrative

Last Reviewed:  12/01/2015

Last Revised: 08/01/2016

Approved:  08/18/2016

Effective Date: 09/01/2016

This policy applies to all physicians, other health care professionals, hospitals and other facilities.

Definitions

Hospital Acquired Condition (HAC)

A condition that is not present when the patient is admitted to or arrives at the hospital or other facility, but occurs during the stay. HACs may be manifested during or after the hospitalization. HACs include preventable infections and medical errors.

Examples include, but are not limited to:

  • Catheter-Associated Urinary Tract Infection (UTI)
  • Vascular Catheter-Associated Infection
  • Surgical Site Infection Following Cardiac Implantable Electronic Device (CIED)
  • Surgical Site Infection, Mediastinitis, Following Coronary Artery Bypass Graft (CABG)
  • Surgical Site Infection Following Certain Orthopedic Procedures:
    • Ankle
    • Elbow
    • Hip
    • Knee
    • Neck
    • Spine
    • Shoulder
  • Surgical Site Infection Following Bariatric Surgery for Obesity:
    • Laparoscopic Gastric Bypas
    • Gastroenterostomy
    • Laparoscopic Gastric Restrictive Surgery
  • Post-operative Hemorrhage
  • Falls and Trauma:
    • Fracture
    • Dislocation
    • Intracranial Injury
    • Crushing Injury
    • Burn
    • Other Injuries
  • Deep Vein Thrombosis and Pulmonary Embolism Following Certain Orthopedic Procedures
    • Total Knee Replacement
    • Hip Replacement
  • New Pressure Ulcers
  • Manifestations of Poor Glycemic Control:
    • Diabetic Ketoacidosis
    • Nonketotic Hyperosmolar Coma
    • Intracranial Injury
    • Hypoglycemic Coma
    • Secondary Diabetes with Ketoacidosis
    • Secondary Diabetes with Hyperosmolarity

Iatrogenic Complications

Any adverse conditions which are the direct result of treatment by a physician or other health care professional.

Examples include, but are not limited to:

  • Air Embolism
  • All Iatrogenic injuries
  • Blood Incompatibility
  • Misplaced instrumentation
  • Iatrogenic Pneumothorax with Venous Catheterization
  • Cerebrospinal fluid (CSF) leaks from intraoperative dural injury

Never Events

Errors in medical care that are of concern to both the public and health care professionals and providers and of a nature such that the risk of occurrence is significantly influenced by the policies and procedures of the health care organization.  For purposes of this policy the term Serious Reportable Event is synonymous with term Never Event.  Examples include, but are not limited to:

  • Performance of the wrong operation/procedure on a patient.
  • Performance of the correct operation/procedure on the wrong side of the body.
  • Unintended retention of a foreign object after surgery.
  • Patient death or serious injury associated with unsafe administration of blood products.
  • Discharge or release of a patient/resident of any age, who is unable to make decisions, to other than an authorized person.

Serious Reportable Events (SRE)

Events that could have reasonably been prevented through application of evidence-based guidelines.  SREs are commonly referred to as "Never Events". These conditions are not present on admission, or when the patients are initially treated, but occur during the course of treatment or stay.

Modifiers and diagnosis codes which could indicate a Serious Reportable Event include, but are not limited to:

  • Healthcare Common Procedure Code Ssystem (HCPCS) modifiers:
    • PA - is used when surgery or other invasive procedure is performed on the wrong site.
    • PB - is used when surgery or other invasive procedure is performed on the wrong patient.
    • PC - is used when the wrong surgery or other invasive procedure is performed on a patient.

This policy applies to the ICD diagnoses codes including but not limited to those listed in Appendices A and B of this policy.  In the course of our normal claims processing we may also identify other claims using Utilization Management, Post-Payment processes, Preauthorization, Case Management, Appeals or other means.

Policy statement

Participating physicians, other health care professionals, hospitals and other facilities will not be reimbursed nor allowed to retain reimbursement for costs incurred as a result of Hospital Acquired Conditions, Iatrogenic Complications, Never Events or Serious Reportable Events. The reduction in reimbursement will be calculated using the reimbursement methodologies in place for the provider at the time of service, and could include part or all of an episode of care.  Our health plan will consider reimbursement for anticipated Hospital Acquired Conditions after high-risk non-elective procedures, such as repair of major trauma.

No providers involved in care when a Never Event occurs will be reimbursed for those services.

Physicians, other health care professionals, hospitals and other facilities will be reimbursed for costs incurred to treat an iatrogenic complication if that physician, other health care professional, hospital or other facility was not the primary practitioner performing the service causing the iatrogenic complication and/or the primary hospital or facility where the iatrogenic complication occurred.

Physicians, other health care professionals, hospitals and other facilities are expected to report to our health plan all Never Events using the appropriate modifiers and diagnosis codes.

We will consider coverage for services not related to the hospital-acquired conditions if you send us itemized statements.

References

Centers for Medicare & Medicaid Services (CMS) Coverage Decision Memos: NCA Tracking Nos. CAG-00401N, CAG-00402N, CAG-00403N

Centers for Medicare & Medicaid Services (CMS), "Hospital-Acquired Conditions (HAC) in Acute Inpatient Prospective Payment System (IPPS) Hospitals." Medicare Learning Network (PDF), October 2012.  

Centers for Medicare & Medicaid Services (CMS), "National Coverage Determination (NCD) for Wrong Surgical or Other Invasive Procedure Performed on a Patient (140.6)."

Centers for Medicare & Medicaid Services (CMS), "National Coverage Determination (NCD) for Surgical or Other Invasive Procedure Performed on the Wrong Body Part (140.7)."

Centers for Medicare & Medicaid Services (CMS), "National Coverage Determination (NCD) for Surgical or Other Invasive Procedure Performed on the Wrong Patient (140.8)."

U.S. Deparment of Health and Human Services - Agency for Healthcare Research and Quality (AHRQ), Patient Safey Primer, "Serious Reportable Events in Healthcare – 2011 Update."

Cross References

None

Appendix A

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)

Below is a list of ICD-9-CM diagnoses that could indicate Hospital Acquired Conditions and Never Events, but are not limited to the following:

ICD-9

ICD-9 Description

9950

Other anaphylactic reaction

99702

Iatrogenic cerebrovascular infarction or hemorrhage (98-14)

99731

Ventilator associated pneumonia (08-14)

99732

Post procedural aspiration pneumonia (11-14)

99801

Postoperative shock, cardiogenic (11-14)

99802

Postoperative shock, septic (11-14)

99811

Hemorrhage complicating a procedure (98-14)

99812

Hematoma complicating a procedure (98-14)

99813

Seroma complicating a procedure (98-14)

9982

Accidental puncture or laceration during a procedure, not elsewhere classified (98-14)

9984

Foreign body accidentally left during a procedure (98-14)

99851

Infected postoperative seroma (98-14)

9987

Acute reaction to foreign substance accidentally left during a procedure (98-14)

99881

Emphysema (subcutaneous) (surgical) resulting from procedure (98-14)

99882

Cataract fragments in eye following cataract surgery (98-14)

9991

Air embolism as a complication of medical care, not elsewhere classified (98-14)

99960

ABO incompatibility reaction, unspecified (10-14)

99961

ABO incompatibility with hemolytic transfusion reaction not specified as acute or delayed (10-14)

99962

ABO incompatibility with acute hemolytic transfusion reaction (10-14)

99963

ABO incompatibility with delayed hemolytic transfusion reaction (10-14)

99969

Other ABO incompatibility reaction (10-14)

99970

Rh incompatibility reaction, unspecified (10-14)

99971

Rh incompatibility with hemolytic transfusion reaction not specified as acute or delayed (10-14)

99972

Rh incompatibility with acute hemolytic transfusion reaction (10-14)

99973

Rh incompatibility with delayed hemolytic transfusion reaction (10-14)

99974

Other Rh incompatibility reaction (10-14)

99975

Non-ABO incompatibility reaction, unspecified (10-14)

99976

Non-ABO incompatibility with hemolytic transfusion reaction not specified as acute or delayed (10-14)

99977

Non-ABO incompatibility with acute hemolytic transfusion reaction (10-14)

99978

Non-ABO incompatibility with delayed hemolytic transfusion reaction (10-14)

99979

Other non-ABO incompatibility reaction (10-14)

99980

Transfusion reaction, unspecified (10-14)

99981

Extravasation of vesicant chemotherapy (08-14)

99982

Extravasation of other vesicant agent (08-14)

99983

Hemolytic transfusion reaction, incompatibility unspecified (10-14)

99984

Acute hemolytic transfusion reaction, incompatibility unspecified (10-14)

99985

Delayed hemolytic transfusion reaction, incompatibility unspecified (10-14)

E870.0 to
E876.9

Misadventures During Surgical and Medical Care

 

Appendix B

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)

Below is a list of ICD-10-CM diagnoses that could indicate Hospital Acquired Conditions and Never Events, but are not limited to the following:

ICD-10

ICD-10 Description

D7801

Intraoperative hemorrhage and hematoma of the spleen complicating a procedure on the spleen (08-14)

D7802

Intraoperative hemorrhage and hematoma of the spleen complicating other procedure (08-14)

D7811

Accidental puncture and laceration of the spleen during a procedure on the spleen (08-14)

D7812

Accidental puncture and laceration of the spleen during other procedure (08-14)

D7821

Post procedural hemorrhage and hematoma of the spleen following a procedure on the spleen (08-14)

D7822

Post procedural hemorrhage and hematoma of the spleen following other procedure (08-14)

E3601

Intraoperative hemorrhage and hematoma of an endocrine system organ or structure complicating an endocrine system procedure (08-14)

E3602

Intraoperative hemorrhage and hematoma of an endocrine system organ or structure complicating other procedure (08-14)

E3611

Accidental puncture and laceration of an endocrine system organ or structure during an endocrine system procedure (08-14)

E3612

Accidental puncture and laceration of an endocrine system organ or structure during other procedure (08-14)

G9731

Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating a nervous system procedure (08-14)

G9732

Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating other procedure (08-14)

G9748

Accidental puncture and laceration of other nervous system organ or structure during a nervous system procedure (09-14)

G9749

Accidental puncture and laceration of other nervous system organ or structure during other procedure (09-14)

G9751

Post procedural hemorrhage and hematoma of a nervous system organ or structure following a nervous system procedure (08-14)

G9752

Post procedural hemorrhage and hematoma of a nervous system organ or structure following other procedure (08-14)

H59021

Cataract (lens) fragments in eye following cataract surgery, right eye (08-14)

H59022

Cataract (lens) fragments in eye following cataract surgery, left eye (08-14)

H59023

Cataract (lens) fragments in eye following cataract surgery, bilateral (08-14)

H59029

Cataract (lens) fragments in eye following cataract surgery, unspecified eye (08-14)

H59111

Intraoperative hemorrhage and hematoma of right eye and adnexa complicating an ophthalmic procedure (08-14)

H59112

Intraoperative hemorrhage and hematoma of left eye and adnexa complicating an ophthalmic procedure (08-14)

H59113

Intraoperative hemorrhage and hematoma of eye and adnexa complicating an ophthalmic procedure, bilateral (08-14)

H59119

Intraoperative hemorrhage and hematoma of unspecified eye and adnexa complicating an ophthalmic procedure (08-14)

H59121

Intraoperative hemorrhage and hematoma of right eye and adnexa complicating other procedure (08-14)

H59122

Intraoperative hemorrhage and hematoma of left eye and adnexa complicating other procedure (08-14)

H59123

Intraoperative hemorrhage and hematoma of eye and adnexa complicating other procedure, bilateral (08-14)

H59129

Intraoperative hemorrhage and hematoma of unspecified eye and adnexa complicating other procedure (08-14)

H59211

Accidental puncture and laceration of right eye and adnexa during an ophthalmic procedure (08-14)

H59212

Accidental puncture and laceration of left eye and adnexa during an ophthalmic procedure (08-14)

H59213

Accidental puncture and laceration of eye and adnexa during an ophthalmic procedure, bilateral (08-14)

H59219

Accidental puncture and laceration of unspecified eye and adnexa during an ophthalmic procedure (08-14)

H59221

Accidental puncture and laceration of right eye and adnexa during other procedure (08-14)

H59222

Accidental puncture and laceration of left eye and adnexa during other procedure (08-14)

H59223

Accidental puncture and laceration of eye and adnexa during other procedure, bilateral (08-14)

H59229

Accidental puncture and laceration of unspecified eye and adnexa during other procedure (08-14)

H59311

Post procedural hemorrhage and hematoma of right eye and adnexa following an ophthalmic procedure (08-14)

H59312

Post procedural hemorrhage and hematoma of left eye and adnexa following an ophthalmic procedure (08-14)

H59313

Post procedural hemorrhage and hematoma of eye and adnexa following an ophthalmic procedure, bilateral (08-14)

H59319

Post procedural hemorrhage and hematoma of unspecified eye and adnexa following an ophthalmic procedure (08-14)

H59321

Post procedural hemorrhage and hematoma of right eye and adnexa following other procedure (08-14)

H59322

Post procedural hemorrhage and hematoma of left eye and adnexa following other procedure (08-14)

H59323

Post procedural hemorrhage and hematoma of eye and adnexa following other procedure, bilateral (08-14)

H59329

Post procedural hemorrhage and hematoma of unspecified eye and adnexa following other procedure (08-14)

H9521

Intraoperative hemorrhage and hematoma of ear and mastoid process complicating a procedure on the ear and mastoid process (08-14)

H9522

Intraoperative hemorrhage and hematoma of ear and mastoid process complicating other procedure (08-14)

H9531

Accidental puncture and laceration of the ear and mastoid process during a procedure on the ear and mastoid process (08-14)

H9532

Accidental puncture and laceration of the ear and mastoid process during other procedure (08-14)

H9541

Post procedural hemorrhage and hematoma of ear and mastoid process following a procedure on the ear and mastoid process (08-14)

H9542

Post procedural hemorrhage and hematoma of ear and mastoid process following other procedure (08-14)

I97410

Intraoperative hemorrhage and hematoma of a circulatory system organ or structure complicating a cardiac catheterization (08-14)

I97411

Intraoperative hemorrhage and hematoma of a circulatory system organ or structure complicating a cardiac bypass (08-14)

I97418

Intraoperative hemorrhage and hematoma of a circulatory system organ or structure complicating other circulatory system procedure (08-14)

I9742

Intraoperative hemorrhage and hematoma of a circulatory system organ or structure complicating other procedure (08-14)

I9751

Accidental puncture and laceration of a circulatory system organ or structure during a circulatory system procedure (08-14)

I9752

Accidental puncture and laceration of a circulatory system organ or structure during other procedure (08-14)

I97610

Post procedural hemorrhage and hematoma of a circulatory system organ or structure following a cardiac catheterization (08-14)

I97611

Post procedural hemorrhage and hematoma of a circulatory system organ or structure following cardiac bypass (08-14)

I97618

Post procedural hemorrhage and hematoma of a circulatory system organ or structure following other circulatory system procedure (08-14)

I9762

Post procedural hemorrhage and hematoma of a circulatory system organ or structure following other procedure (08-14)

I97810

Intraoperative cerebrovascular infarction during cardiac surgery (08-14)

I97811

Intraoperative cerebrovascular infarction during other surgery (08-14)

I97820

Post procedural cerebrovascular infarction during cardiac surgery (08-14)

I97821

Post procedural cerebrovascular infarction during other surgery (08-14)

J189

Pneumonia, unspecified organism (08-14)

J9561

Intraoperative hemorrhage and hematoma of a respiratory system organ or structure complicating a respiratory system procedure (08-14)

J9562

Intraoperative hemorrhage and hematoma of a respiratory system organ or structure complicating other procedure (08-14)

J9571

Accidental puncture and laceration of a respiratory system organ or structure during a respiratory system procedure (08-14)

J9572

Accidental puncture and laceration of a respiratory system organ or structure during other procedure (08-14)

J95830

Post procedural hemorrhage and hematoma of a respiratory system organ or structure following a respiratory system procedure (08-14)

J95831

Post procedural hemorrhage and hematoma of a respiratory system organ or structure following other procedure (08-14)

J95851

Ventilator associated pneumonia (09-14)

J9589

Other post procedural complications and disorders of respiratory system, not elsewhere classified (08-14)

K9161

Intraoperative hemorrhage and hematoma of a digestive system organ or structure complicating a digestive sytem procedure (08-14)

K9162

Intraoperative hemorrhage and hematoma of a digestive system organ or structure complicating other procedure (08-14)

K9171

Accidental puncture and laceration of a digestive system organ or structure during a digestive system procedure (08-14)

K9172

Accidental puncture and laceration of a digestive system organ or structure during other procedure (08-14)

K91840

Post procedural hemorrhage and hematoma of a digestive system organ or structure following a digestive system procedure (08-14)

K91841

Post procedural hemorrhage and hematoma of a digestive system organ or structure following other procedure (08-14)

L7601

Intraoperative hemorrhage and hematoma of skin and subcutaneous tissue complicating a dermatologic procedure (08-14)

L7602

Intraoperative hemorrhage and hematoma of skin and subcutaneous tissue complicating other procedure (08-14)

L7611

Accidental puncture and laceration of skin and subcutaneous tissue during a dermatologic procedure (08-14)

L7612

Accidental puncture and laceration of skin and subcutaneous tissue during other procedure (08-14)

L7621

Post procedural hemorrhage and hematoma of skin and subcutaneous tissue following a dermatologic procedure (08-14)

L7622

Post procedural hemorrhage and hematoma of skin and subcutaneous tissue following other procedure (08-14)

M96810

Intraoperative hemorrhage and hematoma of a musculoskeletal structure complicating a musculoskeletal system procedure (08-14)

M96811

Intraoperative hemorrhage and hematoma of a musculoskeletal structure complicating other procedure (08-14)

M96820

Accidental puncture and laceration of a musculoskeletal structure during a musculoskeletal system procedure (08-14)

M96821

Accidental puncture and laceration of a musculoskeletal structure during other procedure (08-14)

M96830

Post procedural hemorrhage and hematoma of a musculoskeletal structure following a musculoskeletal system procedure (08-14)

M96831

Post procedural hemorrhage and hematoma of a musculoskeletal structure following other procedure (08-14)

N9961

Intraoperative hemorrhage and hematoma of a genitourinary system organ or structure complicating a genitourinary system procedure (08-14)

N9962

Intraoperative hemorrhage and hematoma of a genitourinary system organ or structure complicating other procedure (08-14)

N9971

Accidental puncture and laceration of a genitourinary system organ or structure during a genitourinary system procedure (08-14)

N9972

Accidental puncture and laceration of a genitourinary system organ or structure during other procedure (08-14)

N99820

Post procedural hemorrhage and hematoma of a genitourinary system organ or structure following a genitourinary system procedure (08-14)

N99821

Post procedural hemorrhage and hematoma of a genitourinary system organ or structure following other procedure (08-14)

T800XXA

Air embolism following infusion, transfusion and therapeutic injection, initial encounter (08-14)

T800XXD

Air embolism following infusion, transfusion and therapeutic injection, subsequent encounter (08-14)

T8030XA

ABO incompatibility reaction due to transfusion of blood or blood products, unspecified, initial encounter (10-14)

T8030XD

ABO incompatibility reaction due to transfusion of blood or blood products, unspecified, subsequent encounter (10-14)

T80310A

ABO incompatibility with acute hemolytic transfusion reaction, initial encounter (10-14)

T80310D

ABO incompatibility with acute hemolytic transfusion reaction, subsequent encounter (10-14)

T80311A

ABO incompatibility with delayed hemolytic transfusion reaction, initial encounter (10-14)

T80311D

ABO incompatibility with delayed hemolytic transfusion reaction, subsequent encounter (10-14)

T80319A

ABO incompatibility with hemolytic transfusion reaction, unspecified, initial encounter (10-14)

T80319D

ABO incompatibility with hemolytic transfusion reaction, unspecified, subsequent encounter (10-14)

T8039XA

Other ABO incompatibility reaction due to transfusion of blood or blood products, initial encounter (10-14)

T8039XD

Other ABO incompatibility reaction due to transfusion of blood or blood products, subsequent encounter (10-14)

T8040XA

Rh incompatibility reaction due to transfusion of blood or blood products, unspecified, initial encounter (10-14)

T8040XD

Rh incompatibility reaction due to transfusion of blood or blood products, unspecified, subsequent encounter (10-14)

T80410A

Rh incompatibility with acute hemolytic transfusion reaction, initial encounter (10-14)

T80410D

Rh incompatibility with acute hemolytic transfusion reaction, subsequent encounter (10-14)

T80411A

Rh incompatibility with delayed hemolytic transfusion reaction, initial encounter (10-14)

T80411D

Rh incompatibility with delayed hemolytic transfusion reaction, subsequent encounter (10-14)

T80419A

Rh incompatibility with hemolytic transfusion reaction, unspecified, initial encounter (10-14)

T80419D

Rh incompatibility with hemolytic transfusion reaction, unspecified, subsequent encounter (10-14)

T8049XA

Other Rh incompatibility reaction due to transfusion of blood or blood products, initial encounter (10-14)

T8049XD

Other Rh incompatibility reaction due to transfusion of blood or blood products, subsequent encounter (10-14)

T80810A

Extravasation of vesicant antineoplastic chemotherapy, initial encounter (09-14)

T80810D

Extravasation of vesicant antineoplastic chemotherapy, subsequent encounter (09-14)

T80818A

Extravasation of other vesicant agent, initial encounter (09-14)

T80818D

Extravasation of other vesicant agent, subsequent encounter (09-14)

T80910A

Acute hemolytic transfusion reaction, unspecified incompatibility, initial encounter (10-14)

T80910D

Acute hemolytic transfusion reaction, unspecified incompatibility, subsequent encounter (10-14)

T80911A

Delayed hemolytic transfusion reaction, unspecified incompatibility, initial encounter (10-14)

T80911D

Delayed hemolytic transfusion reaction, unspecified incompatibility, subsequent encounter (10-14)

T80919A

Hemolytic transfusion reaction, unspecified incompatibility, unspecified as acute or delayed, initial encounter (10-14)

T80919D

Hemolytic transfusion reaction, unspecified incompatibility, unspecified as acute or delayed, subsequent encounter (10-14)

T8092XA

Unspecified transfusion reaction, initial encounter (10-14)

T8092XD

Unspecified transfusion reaction, subsequent encounter (10-14)

T80A0XA

Non-ABO incompatibility reaction due to transfusion of blood or blood products, unspecified, initial encounter (10-14)

T80A0XD

Non-ABO incompatibility reaction due to transfusion of blood or blood products, unspecified, subsequent encounter (10-14)

T80A10A

Non-ABO incompatibility with acute hemolytic transfusion reaction, initial encounter (10-14)

T80A10D

Non-ABO incompatibility with acute hemolytic transfusion reaction, subsequent encounter (10-14)

T80A11A

Non-ABO incompatibility with delayed hemolytic transfusion reaction, initial encounter (10-14)

T80A11D

Non-ABO incompatibility with delayed hemolytic transfusion reaction, subsequent encounter (10-14)

T80A19A

Non-ABO incompatibility with hemolytic transfusion reaction, unspecified, initial encounter (10-14)

T80A19D

Non-ABO incompatibility with hemolytic transfusion reaction, unspecified, subsequent encounter (10-14)

T80A9XA

Other non-ABO incompatibility reaction due to transfusion of blood or blood products, initial encounter (10-14)

T80A9XD

Other non-ABO incompatibility reaction due to transfusion of blood or blood products, subsequent encounter (10-14)

T8111XA

Post procedural  cardiogenic shock, initial encounter (11-14)

T8111XD

Post procedural  cardiogenic shock, subsequent encounter (11-14)

T8112XA

Post procedural septic shock, initial encounter (11-14)

T8112XD

Post procedural septic shock, subsequent encounter (11-14)

T814XXA

Infection following a procedure, initial encounter (08-14)

T814XXD

Infection following a procedure, subsequent encounter (08-14)

T81500A

Unspecified complication of foreign body accidentally left in body following surgical operation, initial encounter (08-14)

T81500D

Unspecified complication of foreign body accidentally left in body following surgical operation, subsequent encounter (08-14)

T81501A

Unspecified complication of foreign body accidentally left in body following infusion or transfusion, initial encounter (08-14)

T81501D

Unspecified complication of foreign body accidentally left in body following infusion or transfusion, subsequent encounter (08-14)

T81502A

Unspecified complication of foreign body accidentally left in body following kidney dialysis, initial encounter (08-14)

T81502D

Unspecified complication of foreign body accidentally left in body following kidney dialysis, subsequent encounter (08-14)

T81503A

Unspecified complication of foreign body accidentally left in body following injection or immunization, initial encounter (08-14)

T81503D

Unspecified complication of foreign body accidentally left in body following injection or immunization, subsequent encounter (08-14)

T81504A

Unspecified complication of foreign body accidentally left in body following endoscopic examination, initial encounter (08-14)

T81504D

Unspecified complication of foreign body accidentally left in body following endoscopic examination, subsequent encounter (08-14)

T81505A

Unspecified complication of foreign body accidentally left in body following heart catheterization, initial encounter (08-14)

T81505D

Unspecified complication of foreign body accidentally left in body following heart catheterization, subsequent encounter (08-14)

T81506A

Unspecified complication of foreign body accidentally left in body following aspiration, puncture or other catheterization, initial encounter (08-14)

T81506D

Unspecified complication of foreign body accidentally left in body following aspiration, puncture or other catheterization, subsequent encounter (08-14)

T81507A

Unspecified complication of foreign body accidentally left in body following removal of catheter or packing, initial encounter (08-14)

T81507D

Unspecified complication of foreign body accidentally left in body following removal of catheter or packing, subsequent encounter (08-14)

T81508A

Unspecified complication of foreign body accidentally left in body following other procedure, initial encounter (08-14)

T81508D

Unspecified complication of foreign body accidentally left in body following other procedure, subsequent encounter (08-14)

T81509A

Unspecified complication of foreign body accidentally left in body following unspecified procedure, initial encounter (08-14)

T81509D

Unspecified complication of foreign body accidentally left in body following unspecified procedure, subsequent encounter (08-14)

T81510A

Adhesions due to foreign body accidentally left in body following surgical operation, initial encounter (08-14)

T81510D

Adhesions due to foreign body accidentally left in body following surgical operation, subsequent encounter (08-14)

T81511A

Adhesions due to foreign body accidentally left in body following infusion or transfusion, initial encounter (08-14)

T81511D

Adhesions due to foreign body accidentally left in body following infusion or transfusion, subsequent encounter (08-14)

T81512A

Adhesions due to foreign body accidentally left in body following kidney dialysis, initial encounter (08-14)

T81512D

Adhesions due to foreign body accidentally left in body following kidney dialysis, subsequent encounter (08-14)

T81513A

Adhesions due to foreign body accidentally left in body following injection or immunization, initial encounter (08-14)

T81513D

Adhesions due to foreign body accidentally left in body following injection or immunization, subsequent encounter (08-14)

T81514A

Adhesions due to foreign body accidentally left in body following endoscopic examination, initial encounter (08-14)

T81514D

Adhesions due to foreign body accidentally left in body following endoscopic examination, subsequent encounter (08-14)

T81515A

Adhesions due to foreign body accidentally left in body following heart catheterization, initial encounter (08-14)

T81515D

Adhesions due to foreign body accidentally left in body following heart catheterization, subsequent encounter (08-14)

T81516A

Adhesions due to foreign body accidentally left in body following aspiration, puncture or other catheterization, initial encounter (08-14)

T81516D

Adhesions due to foreign body accidentally left in body following aspiration, puncture or other catheterization, subsequent encounter (08-14)

T81517A

Adhesions due to foreign body accidentally left in body following removal of catheter or packing, initial encounter (08-14)

T81517D

Adhesions due to foreign body accidentally left in body following removal of catheter or packing, subsequent encounter (08-14)

T81518A

Adhesions due to foreign body accidentally left in body following other procedure, initial encounter (08-14)

T81518D

Adhesions due to foreign body accidentally left in body following other procedure, subsequent encounter (08-14)

T81519A

Adhesions due to foreign body accidentally left in body following unspecified procedure, initial encounter (08-14)

T81519D

Adhesions due to foreign body accidentally left in body following unspecified procedure, subsequent encounter (08-14)

T81520A

Obstruction due to foreign body accidentally left in body following surgical operation, initial encounter (08-14)

T81520D

Obstruction due to foreign body accidentally left in body following surgical operation, subsequent encounter (08-14)

T81521A

Obstruction due to foreign body accidentally left in body following infusion or transfusion, initial encounter (08-14)

T81521D

Obstruction due to foreign body accidentally left in body following infusion or transfusion, subsequent encounter (08-14)

T81522A

Obstruction due to foreign body accidentally left in body following kidney dialysis, initial encounter (08-14)

T81522D

Obstruction due to foreign body accidentally left in body following kidney dialysis, subsequent encounter (08-14)

T81523A

Obstruction due to foreign body accidentally left in body following injection or immunization, initial encounter (08-14)

T81523D

Obstruction due to foreign body accidentally left in body following injection or immunization, subsequent encounter (08-14)

T81524A

Obstruction due to foreign body accidentally left in body following endoscopic examination, initial encounter (08-14)

T81524D

Obstruction due to foreign body accidentally left in body following endoscopic examination, subsequent encounter (08-14)

T81525A

Obstruction due to foreign body accidentally left in body following heart catheterization, initial encounter (08-14)

T81525D

Obstruction due to foreign body accidentally left in body following heart catheterization, subsequent encounter (08-14)

T81526A

Obstruction due to foreign body accidentally left in body following aspiration, puncture or other catheterization, initial encounter (08-14)

T81526D

Obstruction due to foreign body accidentally left in body following aspiration, puncture or other catheterization, subsequent encounter (08-14)

T81527A

Obstruction due to foreign body accidentally left in body following removal of catheter or packing, initial encounter (08-14)

T81527D

Obstruction due to foreign body accidentally left in body following removal of catheter or packing, subsequent encounter (08-14)

T81528A

Obstruction due to foreign body accidentally left in body following other procedure, initial encounter (08-14)

T81528D

Obstruction due to foreign body accidentally left in body following other procedure, subsequent encounter (08-14)

T81529A

Obstruction due to foreign body accidentally left in body following unspecified procedure, initial encounter (08-14)

T81529D

Obstruction due to foreign body accidentally left in body following unspecified procedure, subsequent encounter (08-14)

T81530A

Perforation due to foreign body accidentally left in body following surgical operation, initial encounter (08-14)

T81530D

Perforation due to foreign body accidentally left in body following surgical operation, subsequent encounter (08-14)

T81531A

Perforation due to foreign body accidentally left in body following infusion or transfusion, initial encounter (08-14)

T81531D

Perforation due to foreign body accidentally left in body following infusion or transfusion, subsequent encounter (08-14)

T81532A

Perforation due to foreign body accidentally left in body following kidney dialysis, initial encounter (08-14)

T81532D

Perforation due to foreign body accidentally left in body following kidney dialysis, subsequent encounter (08-14)

T81533A

Perforation due to foreign body accidentally left in body following injection or immunization, initial encounter (08-14)

T81533D

Perforation due to foreign body accidentally left in body following injection or immunization, subsequent encounter (08-14)

T81534A

Perforation due to foreign body accidentally left in body following endoscopic examination, initial encounter (08-14)

T81534D

Perforation due to foreign body accidentally left in body following endoscopic examination, subsequent encounter (08-14)

T81535A

Perforation due to foreign body accidentally left in body following heart catheterization, initial encounter (08-14)

T81535D

Perforation due to foreign body accidentally left in body following heart catheterization, subsequent encounter (08-14)

T81536A

Perforation due to foreign body accidentally left in body following aspiration, puncture or other catheterization, initial encounter (08-14)

T81536D

Perforation due to foreign body accidentally left in body following aspiration, puncture or other catheterization, subsequent encounter (08-14)

T81537A

Perforation due to foreign body accidentally left in body following removal of catheter or packing, initial encounter (08-14)

T81537D

Perforation due to foreign body accidentally left in body following removal of catheter or packing, subsequent encounter (08-14)

T81538A

Perforation due to foreign body accidentally left in body following other procedure, initial encounter (08-14)

T81538D

Perforation due to foreign body accidentally left in body following other procedure, subsequent encounter (08-14)

T81539A

Perforation due to foreign body accidentally left in body following unspecified procedure, initial encounter (08-14)

T81539D

Perforation due to foreign body accidentally left in body following unspecified procedure, subsequent encounter (08-14)

T81590A

Other complications of foreign body accidentally left in body following surgical operation, initial encounter (08-14)

T81590D

Other complications of foreign body accidentally left in body following surgical operation, subsequent encounter (08-14)

T81591A

Other complications of foreign body accidentally left in body following infusion or transfusion, initial encounter (08-14)

T81591D

Other complications of foreign body accidentally left in body following infusion or transfusion, subsequent encounter (08-14)

T81592A

Other complications of foreign body accidentally left in body following kidney dialysis, initial encounter (08-14)

T81592D

Other complications of foreign body accidentally left in body following kidney dialysis, subsequent encounter (08-14)

T81593A

Other complications of foreign body accidentally left in body following injection or immunization, initial encounter (08-14)

T81593D

Other complications of foreign body accidentally left in body following injection or immunization, subsequent encounter (08-14)

T81594A

Other complications of foreign body accidentally left in body following endoscopic examination, initial encounter (08-14)

T81594D

Other complications of foreign body accidentally left in body following endoscopic examination, subsequent encounter (08-14)

T81595A

Other complications of foreign body accidentally left in body following heart catheterization, initial encounter (08-14)

T81595D

Other complications of foreign body accidentally left in body following heart catheterization, subsequent encounter (08-14)

T81596A

Other complications of foreign body accidentally left in body following aspiration, puncture or other catheterization, initial encounter (08-14)

T81596D

Other complications of foreign body accidentally left in body following aspiration, puncture or other catheterization, subsequent encounter (08-14)

T81597A

Other complications of foreign body accidentally left in body following removal of catheter or packing, initial encounter (08-14)

T81597D

Other complications of foreign body accidentally left in body following removal of catheter or packing, subsequent encounter (08-14)

T81598A

Other complications of foreign body accidentally left in body following other procedure, initial encounter (08-14)

T81598D

Other complications of foreign body accidentally left in body following other procedure, subsequent encounter (08-14)

T81599A

Other complications of foreign body accidentally left in body following unspecified procedure, initial encounter (08-14)

T81599D

Other complications of foreign body accidentally left in body following unspecified procedure, subsequent encounter (08-14)

T8160XA

Unspecified acute reaction to foreign substance accidentally left during a procedure, initial encounter (08-14)

T8160XD

Unspecified acute reaction to foreign substance accidentally left during a procedure, subsequent encounter (08-14)

T8161XA

Aseptic peritonitis due to foreign substance accidentally left during a procedure, initial encounter (08-14)

T8161XD

Aseptic peritonitis due to foreign substance accidentally left during a procedure, subsequent encounter (08-14)

T8169XA

Other acute reaction to foreign substance accidentally left during a procedure, initial encounter (08-14)

T8169XD

Other acute reaction to foreign substance accidentally left during a procedure, subsequent encounter (08-14)

T8182XA

Emphysema (subcutaneous) resulting from a procedure, initial encounter (08-14)

T8182XD

Emphysema (subcutaneous) resulting from a procedure, subsequent encounter (08-14)

T886XXA

Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, initial encounter

T886XXD

Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, subsequent encounter

T888XXA

Other specified complications of surgical and medical care, not elsewhere classified, initial encounter (08-14)

T888XXD

Other specified complications of surgical and medical care, not elsewhere classified, subsequent encounter (08-14)

Y62.0 to Y62.9

Failure of sterile precautions during surgical and medical care

Y63.0 to Y63.9

Failure in dosage during surgical and medical care

Y64.0 TO Y64.9

Contaminated medical or biological substances

Y65.0 to Y65.9

Midadventures during surgical and medical care

Y66

Non-administration of surgical and medical care

Y69

Unspecified misadventures during surgical and medical care

 

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Your use of this Reimbursement Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.