General Surgery Billing Services

Adult Elective Surgery and Procedures Recommendations during COVID-19

To aggressively address COVID-19, CMS recognizes that the conservation of critical resources such as ventilators and Personal Protective Equipment (PPE) is essential, as well as limiting exposure of patients and staff to the SARS-CoV-2 virus. The following recommendations are guidance to limit non-essential adult elective surgery and medical and surgical procedures, including all dental procedures. These considerations will assist in the management of vital healthcare resources during this public health emergency.

Dental procedures use PPE and have one of the highest risks of transmission due to the close proximity of the healthcare provider to the patient. To reduce the risk of spread and to preserve PPE, CMS is recommending that all non-essential dental exams and procedures be postponed until further notice.

A tiered framework is provided to inform health systems as they consider resources and how best to provide surgical services and procedures to those whose condition requires emergent or urgent attention to save a life, preserve organ function, and avoid further harms from underlying condition or disease. Decisions remain the responsibility of local healthcare delivery systems, including state and local health officials, and those surgeons who have a direct responsibility to their patients.

However, in analyzing the risk and benefit of any planned procedure, not only must the clinical situation be evaluated, but resource conservation must also be considered. These recommendations are meant to be refined over the duration of the crisis based on feedback from subject matter experts. At all times, the supply of personal protective equipment (PPE), hospital and intensive care unit beds, and ventilators should be considered, even in areas that are not currently dealing with COVID-19 infections. Therefore, while case-by-case evaluations are made, we suggest that the following factors to be considered as to whether planned surgery should proceed:

  • Current and projected COVID-19 cases in the facility and region.
    • Consider the following tiered approach in the table below to curtail elective surgeries. The decisions should be made in consultation with the hospital, surgeon, patient, and other public health professionals.
  • Supply of PPE to the facilities in the system
  • Staffing availability
  • Bed availability, especially the intensive care unit (ICU) beds
  • Ventilator availability
  • Health and age of the patient, especially given the risks of concurrent COVID-19 infection during recovery
  • The urgency of the procedure

Tiers

Action

Definition

Locations

Examples

Tier 1a Postpone

surgery/

procedure

Low acuity

surgery/healthy

patient outpatient surgery

Not life-threatening

illness

HOPD*

ASC**

Hospital with

low/no COVID19 census

-Carpal tunnel

release

-EGD

-Colonoscopy

-Cataracts

Tier 1b Postpone surgery/

procedure

Low acuity

surgery/unhealthy

patient

HOPD

ASC

Hospital with

low/no COVID19 census

-Endoscopies
Tier 2a Consider postponing

surgery/procedure

Intermediate acuity

surgery/healthy

patient Not life-threatening

but potential for

future morbidity

and mortality.

Requires in-hospital

stay

HOPD

ASC

Hospital with

low/no COVID19 census

-Low-risk cancer

-Non-urgent

spine & Ortho:

Including hip,

knee

replacement and

elective spine

surgery

-Stable ureteral

colic

-Elective

angioplasty

Tier 2b Postpone surgery/

procedure if

possible

Intermediate acuity

surgery/unhealthy

patient

HOPD

ASC

Hospital with

low/no COVID19 census

Tier 3a Do not postpone High acuity

surgery/healthy

patient

Hospital -Most cancers

-Neurosurgery

-Highly

symptomatic

patients

Tier 3b Do not postpone High acuity

surgery/unhealthy

patient

Hospital -Transplants

-Trauma

-Cardiac w/

symptoms

-limb

threatening

vascular surgery

*Hospital Outpatient Department ** Ambulatory Surgery Center

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