Health Information Management

Inpatient-only procedures: Ensure compliance, avoid RAC recoupments

HIM-HIPAA Insider, May 10, 2011

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Inpatient coders may lack familiarity with the ­inpatient-only procedure list because CMS publishes it annually in the OPPS final rule. Nonetheless, they should review this list of CPT® codes and know its implications.
Inpatient-only procedures are those for which CMS has determined patients require at least 24 hours of postoperative care due to the invasive nature of the procedure or the underlying condition. The list clearly distinguishes these procedures from those that may be performed in the outpatient setting, says Deborah K. Hale, CCS, CCDS, president and CEO of Administrative Consultant Service, LLC, in Oklahoma City.
 
Hospitals lament the list because they must ensure that physicians write orders to admit patients prior to performing inpatient-only surgical procedures. Some procedures on the list are also somewhat counterintuitive; some physicians and others view them as procedures that can be performed on an outpatient basis.
 
RACs have only complicated matters.
 
Editor’s note: To read more, access this article in the May issue of Briefings on Coding Compliance Strategies.



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