Name of the Procedure:

Common name(s): Not Medically Necessary Service
Technical/medical term: S9986

Summary

This procedure or service has been identified as not medically necessary. The patient is fully aware and consents to proceeding with the understanding that it may not be covered by insurance and might not provide medical benefits.

Purpose

While the procedure is not deemed medically necessary, it may be pursued for various reasons, such as patient preference or perceived personal benefit. The primary goal is to cater to the patient's request despite the lack of medical necessity.

Indications

The patient should be informed and agreeable to undergoing the procedure without the expectation of medical necessity. This can include elective procedures or treatments that the patient believes might enhance quality of life, aesthetics, or personal well-being.

Preparation

Pre-procedure Instructions:

• Confirm patient consent, ensuring they understand the procedure is not medically necessary.
• Discuss financial implications, including potential out-of-pocket costs.
• Follow any general recommendations provided by the healthcare provider related to the type of procedure.

Diagnostic Tests/Assessments:

• Routine assessments to ensure the patient is fit for the procedure, specific to the nature of the requested service.

Procedure Description

Step-by-Step Explanation:

• Clearly explain the voluntary nature of the procedure.
• Outline the steps involved specific to the type of service requested.

Tools, Equipment, Technology:

• Varies widely based on the specific elective service or procedure being performed.

Anesthesia/Sedation:

• If applicable, specify the type and level of anesthesia or sedation that will be used.

Duration

The duration will vary depending on the specific procedure. This could range from a few minutes to several hours.

Setting

Typically performed in various healthcare settings such as:

• Hospitals
• Outpatient Clinics
• Surgical Centers

Personnel

Involvement of healthcare professionals depends on the procedure:

• Surgeons (if surgery is involved)
• Nurses
• Anesthesiologists (if sedation or anesthesia is needed)
• Technicians

Risks and Complications

Common Risks:

• Pain or discomfort
• Infection at the site (for surgical procedures)
• Bleeding (if invasive)

Rare Risks:

• Severe allergic reactions to medications or anesthesia
• Unexpected complications specific to the patient’s health status

Management:

• Pre-procedure evaluation to mitigate risks
• Post-procedure monitoring and care instructions

Benefits

Expected benefits include personal satisfaction and potential enhancement in quality of life as perceived by the patient. The timeline for realizing these benefits is highly variable.

Recovery

Post-procedure Care:

• Follow specific care instructions provided by healthcare professionals.
• Adhere to prescribed medication regimens if applicable.

Expected Recovery Time:

• Varies greatly depending on the procedure performed.

Restrictions & Follow-up:

• Specific to the elective service; follow recommended guidelines concerning physical activity and follow-up visits.

Alternatives

Other Treatment Options:

• No treatment, natural progression, or conservative management.
• Seeking second opinions regarding medical necessity.

Pros and Cons:

• Alternatives should be discussed in the context of achieving patient’s goals without unnecessary procedures.

Patient Experience

During the Procedure:

• Experience will vary according to the specific nature of the elective service, anesthesia involvement, and individual pain tolerance.

After the Procedure:

• Mild to moderate pain or discomfort depending on invasiveness.
• Pain management will be individualized to ensure comfort and recovery.

--- This markdown text provides a comprehensive overview of HCPCS procedure S9986, detailing what patients can expect and emphasizing the importance of informed consent and awareness regarding the non-medical necessity of the service.