Surgical or Other Invasive Procedure Performed on the Wrong Patient

CMS does not cover surgical or other invasive procedures performed on the wrong patient; coverage is denied when the procedure was intended for a different patient and is not reasonable and necessary for the Medicare beneficiary. A procedure is considered performed on the wrong patient if it is inconsistent with the correctly documented informed consent. The rule applies to operative and invasive procedures listed in the CPT surgery section (including angioplasty, cardiac catheterization, biopsies, transplant), but excludes very minor noninvasive exams such as otoscopy and drawing blood.

"No nationally covered indications — CMS does not provide coverage for procedures performed on the wrong patient."

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