Wrong Surgical or Other Invasive Procedure Performed on a Patient

CMS does not cover procedures performed in error (wrong surgical or other invasive procedures) when the performed procedure is not reasonable and necessary for the beneficiary and is inconsistent with the correctly documented informed consent. Exceptions where the event is not considered erroneous (and thus not subject to non-coverage) include emergent situations that preclude consent, justified intraoperative changes when a second surgery poses greater risk, and discovery of unusual anatomy; the policy applies to operative and invasive procedures as defined and excludes very minor non-invasive examinations such as otoscope use or drawing blood.

"CMS does not cover a surgical or other invasive procedure when a practitioner erroneously performs a different procedure because that performed procedure is not reasonable and necessary for the Med..."

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