Surgical or Other Invasive Procedure Performed on the Wrong Body Part

CMS will not cover surgical or other invasive procedures that were erroneously performed on the wrong body part — i.e., procedures inconsistent with a correctly documented informed consent (for example, wrong side or wrong spinal level). Exceptions where the event is not considered erroneous (and thus not non-covered) include emergent situations that preclude consent and intraoperative discoveries or unusual anatomy when risk of a second operation outweighs benefits; the policy applies to operative and invasive procedures as defined and excludes very minor examinations such as otoscopy or drawing blood.

"CMS does not cover a surgical or other invasive procedure when the practitioner erroneously performs the procedure on the wrong body part because that procedure is not a reasonable and necessary tr..."

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