Health Information Management

Q/A: Inpatient-only procedures

APCs Insider, November 5, 2010

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Q: Did CMS remove any more procedures from the inpatient-only list for 2011?

A: Yes. In the2011 OPPS final rule released November 2, CMS finalized the removal of three codes from the inpatient-only list:

  • 21193, Reconstruction of mandibular rami; horizontal, vertical, C, or L osteotomy; without bone graft
  • 21395, Open treatment of orbital floor blowout fracture; periorbital approach with bone graft (includes obtaining graft)
  • 25909, Amputation, forearm, through radius and ulna; reamputation

All three procedures have a status indicator of T. Codes 21193 and 21395 fall under APC 0256, while 25909 is part of APC 0049.

The inpatient list specifies those services that CMS will only reimburse the hospital when these services are provided in the inpatient setting because of:

  • The nature of the procedure
  • The underlying physical condition of the patient or
  • The need for at least 24 hours of postoperative recovery time or monitoring before the patient can be safely discharged



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