Home Administrative Billing & Reimbursement BlueCard® Health and Wellness Medical PEAR portal Pharmacy Products Quality Management

Updated policy for Never Events and Preventable Adverse Events

November 30, 2012

[

Never Events and Preventable Adverse Events are considered adverse events or errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients. They address injuries caused by errors in medical and surgical management and errors that occur as a result of a failure to follow standards of care or hospital policies and procedures.

Based on recent regulations published by the Centers for Medicare & Medicaid Services (CMS), our Claim Payment Policy #00.01.44e: Never Events and Preventable Adverse Events will be updated as outlined below and will be effective February 5, 2013.

The following Hospital Acquired Conditions and associated diagnosis and procedure codes will be added to the section of the policy addressing preventable adverse events:

Preventable Adverse Event

Diagnosis code

Associated procedure codes

Surgical Site Infection (SSI) Following Cardiac Implantable Electronic Device (CIED) Procedures

996.61 Infection and inflammatory reaction due to cardiac device, implant and graft

998.59 Other postoperative infection

00.50 ? 00.54; 37.74 ? 37.77; 37.79; 37.80 ? 37.83; 37.85 ? 37.87; 37.89; 37.94; 37.96; 37.98

latrogenic Pneumothorax With Venous Catheterization

512.1 Iatrogenic Pneumothorax

38.93

The following two diagnoses codes will be added to Vascular Catheter-Associated Infection:

999.32 Bloodstream infection due to central venous catheter

999.33 Local infection due to central venous catheter

For questions or additional information related to Never Events and Preventable Adverse Events, please contact your Network Coordinator.

NaviNet? is a registered trademark of NaviNet Inc., an independent company.

]

This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
Connect with us     Facebook     Twitter     Flickr     YouTube     Walk the Talk    Independence Pinterest    Independence LinkedIn    Independence Instagram Site Map        Anti-Fraud        Privacy Policy        Legal        Disclaimer
© 2023 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.