Provider preventable conditions are those serious medical mistakes that should never happen and thus are deemed “never events.”
Priority Health will not pay for preventable events that occur in the operating room. All services provided in the operation room or other healthcare setting when this medical error occurs are considered part of the event and therefore, not reimbursed.
Related Medical Policy: Medical Errors: Serious Reportable Events/ Hospital Acquired Conditions– 91516
The following modifiers should be appended when a preventable event occurs:
PA – Surgical or other invasive procedure on wrong body part
PB – Surgical or other invasive procedure on wrong patient
PC - Wrong surgery or other invasive procedure on patient
Inappropriate use:
• Non-surgical and non-invasive CPT/HCPCS codes