{"id":11150,"date":"2020-05-04T13:12:51","date_gmt":"2020-05-04T07:42:51","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=11150"},"modified":"2020-05-04T13:12:51","modified_gmt":"2020-05-04T07:42:51","slug":"adult-elective-surgery-and-procedures-recommendations-during-covid-19","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/adult-elective-surgery-and-procedures-recommendations-during-covid-19\/","title":{"rendered":"Adult Elective Surgery and Procedures Recommendations during COVID-19"},"content":{"rendered":"<p style=\"text-align: justify;\">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 <a href=\"https:\/\/www.medicalbillersandcoders.com\/speciality\/dental-medical-billing-services.html\">dental<\/a> procedures. These considerations will assist in the management of vital healthcare resources during this public health emergency.<\/p>\n<p style=\"text-align: justify;\">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.<\/p>\n<p style=\"text-align: justify;\">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.<\/p>\n<p style=\"text-align: justify;\">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 <a href=\"https:\/\/goo.gl\/4GoXKg\">surgery<\/a> should proceed:<\/p>\n<ul style=\"text-align: justify;\">\n<li style=\"text-align: left;\">Current and projected COVID-19 cases in the facility and region.\n<ul>\n<li>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.<\/li>\n<\/ul>\n<\/li>\n<li style=\"text-align: left;\">Supply of PPE to the facilities in the system<\/li>\n<li style=\"text-align: left;\">Staffing availability<\/li>\n<li style=\"text-align: left;\">Bed availability, especially the intensive care unit (ICU) beds<\/li>\n<li style=\"text-align: left;\">Ventilator availability<\/li>\n<li style=\"text-align: left;\">Health and age of the patient, especially given the risks of concurrent COVID-19 infection during recovery<\/li>\n<li style=\"text-align: left;\">The urgency of the procedure<\/li>\n<\/ul>\n<table>\n<tbody>\n<tr>\n<td width=\"64\">\n<h3 style=\"text-align: center;\">Tiers<\/h3>\n<\/td>\n<td style=\"text-align: center;\" width=\"132\">\n<h3>Action<\/h3>\n<\/td>\n<td style=\"text-align: center;\" width=\"174\">\n<h3>Definition<\/h3>\n<\/td>\n<td style=\"text-align: center;\" width=\"123\">\n<h3>Locations<\/h3>\n<\/td>\n<td width=\"123\">\n<h3 style=\"text-align: center;\">Examples<\/h3>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"64\">Tier 1a<\/td>\n<td width=\"132\">Postpone<\/p>\n<p>surgery\/<\/p>\n<p>procedure<\/td>\n<td width=\"174\">Low acuity<\/p>\n<p>surgery\/healthy<\/p>\n<p>patient outpatient surgery<\/p>\n<p>Not life-threatening<\/p>\n<p>illness<\/td>\n<td width=\"123\">HOPD*<\/p>\n<p>ASC**<\/p>\n<p>Hospital with<\/p>\n<p>low\/no COVID19 census<\/td>\n<td width=\"123\">-Carpal tunnel<\/p>\n<p>release<\/p>\n<p>-EGD<\/p>\n<p>-Colonoscopy<\/p>\n<p>-Cataracts<\/td>\n<\/tr>\n<tr>\n<td width=\"64\">Tier 1b<\/td>\n<td width=\"132\">Postpone surgery\/<\/p>\n<p>procedure<\/td>\n<td width=\"174\">Low acuity<\/p>\n<p>surgery\/unhealthy<\/p>\n<p>patient<\/td>\n<td width=\"123\">HOPD<\/p>\n<p>ASC<\/p>\n<p>Hospital with<\/p>\n<p>low\/no COVID19 census<\/td>\n<td width=\"123\">-Endoscopies<\/td>\n<\/tr>\n<tr>\n<td width=\"64\">Tier 2a<\/td>\n<td width=\"132\">Consider postponing<\/p>\n<p>surgery\/procedure<\/td>\n<td width=\"174\">Intermediate acuity<\/p>\n<p>surgery\/healthy<\/p>\n<p>patient Not life-threatening<\/p>\n<p>but potential for<\/p>\n<p>future morbidity<\/p>\n<p>and mortality.<\/p>\n<p>Requires in-hospital<\/p>\n<p>stay<\/td>\n<td width=\"123\">HOPD<\/p>\n<p>ASC<\/p>\n<p>Hospital with<\/p>\n<p>low\/no COVID19 census<\/td>\n<td width=\"123\">-Low-risk cancer<\/p>\n<p>-Non-urgent<\/p>\n<p>spine &amp; Ortho:<\/p>\n<p>Including hip,<\/p>\n<p>knee<\/p>\n<p>replacement and<\/p>\n<p>elective spine<\/p>\n<p>surgery<\/p>\n<p>-Stable ureteral<\/p>\n<p>colic<\/p>\n<p>-Elective<\/p>\n<p>angioplasty<\/td>\n<\/tr>\n<tr>\n<td width=\"64\">Tier 2b<\/td>\n<td width=\"132\">Postpone surgery\/<\/p>\n<p>procedure if<\/p>\n<p>possible<\/td>\n<td width=\"174\">Intermediate acuity<\/p>\n<p>surgery\/unhealthy<\/p>\n<p>patient<\/td>\n<td width=\"123\">HOPD<\/p>\n<p>ASC<\/p>\n<p>Hospital with<\/p>\n<p>low\/no COVID19 census<\/td>\n<td width=\"123\"><\/td>\n<\/tr>\n<tr>\n<td width=\"64\">Tier 3a<\/td>\n<td width=\"132\">Do not postpone<\/td>\n<td width=\"174\">High acuity<\/p>\n<p>surgery\/healthy<\/p>\n<p>patient<\/td>\n<td width=\"123\">Hospital<\/td>\n<td width=\"123\">-Most cancers<\/p>\n<p>-Neurosurgery<\/p>\n<p>-Highly<\/p>\n<p>symptomatic<\/p>\n<p>patients<\/td>\n<\/tr>\n<tr>\n<td width=\"64\">Tier 3b<\/td>\n<td width=\"132\">Do not postpone<\/td>\n<td width=\"174\">High acuity<\/p>\n<p>surgery\/unhealthy<\/p>\n<p>patient<\/td>\n<td width=\"123\">Hospital<\/td>\n<td width=\"123\">-Transplants<\/p>\n<p>-Trauma<\/p>\n<p>-Cardiac w\/<\/p>\n<p>symptoms<\/p>\n<p>-limb<\/p>\n<p>threatening<\/p>\n<p>vascular surgery<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\">*Hospital Outpatient Department ** <a href=\"https:\/\/goo.gl\/NfC3iD\">Ambulatory Surgery Center<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>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. [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":11151,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1162],"tags":[746,921,922,80,747,359,778,737,738,46,47,750,686,1163,1165,751,15,417,162,724,9,11,64,16,339,146,192,753,150,754,418,144,815,816,939,904,58,34,27,785,940],"class_list":["post-11150","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general-surgery-billing-services","tag-billing-services-for-doctors","tag-coronavirus","tag-covid-19","tag-cpt-codes","tag-cpthcpcs","tag-dme-billing-services","tag-dmepos","tag-e-m-codes","tag-e-m-services","tag-ehr","tag-emr-ehr-health-it","tag-general-surgery-billing","tag-general-surgery-billing-services","tag-general-surgery-coding-guidelines","tag-general-surgery-medical-billing","tag-hcpcs-code","tag-medical-billing","tag-medical-billing-agencies","tag-medical-billing-and-coding-services","tag-medical-billing-audit","tag-medical-billing-companies","tag-medical-billing-outsourcing","tag-medical-billing-practices","tag-medical-billing-service","tag-medical-coding-audits","tag-medicare-2","tag-medicare-medicaid-services","tag-medicare-billing","tag-medicare-claims","tag-modifier","tag-online-medical-billing","tag-outsource-medical-billing","tag-outsourced-medical-billing-company","tag-outsourced-medical-billing-services","tag-patient-collection","tag-prior-authorization","tag-rcm","tag-reimbursement","tag-revenue-cycle-management-2","tag-telehealth","tag-telehealth-coverage"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.0 (Yoast SEO v28.0) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Adult Elective Surgery | Procedures Recommendations during COVID-19<\/title>\n<meta name=\"description\" content=\"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. 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