Q&A: Charging for cancelled surgeries

Q: Can you charge a cancelled surgery if the patient is not taken to the procedure room?

A: If the patient has not entered the room, no operating room charges would generate (time in through time out), so there is no charge for the room. We would consider this a cancelled procedure and document the reason why it was cancelled.

If the case is cancelled for clinical reasons after the patient enters the room, the start time is documented, the end time is documented for the time it was cancelled, and the reason would be documented in the medical record. This is chargeable and the CPT® code on the claim would carry an appropriate modifier.

If the patient enters the room and the procedure is cancelled due to a technical/operational issue unrelated to the clinical situation of the patient, we would consider the charge process on a case-by-case basis (generally non-chargeable).

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