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December 2016 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 4 Outpatient Hospital (Medical and Surgical Acute Care Outpatient Facility) : 4.2 Services, Benefits, Limitations, and Prior Authorization : 4.2.3 Day Surgery : 4.2.3.6 Incomplete Day Surgeries

4.2.3.6
Facilities must use either one of the following diagnosis codes or one of the following modifiers to indicate that a surgical procedure (type of service F) was not completed:
 
 
Providers must submit the following documentation with the claim:
Reimbursement to HASC facilities for canceled or incomplete surgeries because of patient complications, is made according to the following criteria, depending on the extent to which the anesthesia or surgery proceeded:
Reimburse at 0 percent of HASC group payment schedule for a procedure that is terminated for nonmedical or medical reasons before the facility has expended substantial resources.
Surgeries canceled because of incomplete pre-operative procedures are not reimbursed.

Texas Medicaid & Healthcare Partnership
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