Health Information Management

Review and reevaluate the process for identifying inpatient-only procedures

HIM-HIPAA Insider, July 7, 2014

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CMS' introduction of the 2-midnight rule in the 2014 IPPS final rule makes properly identifying inpatient-only procedures even more important for hospitals.
CMS designates certain procedures as inpatient-only, meaning it will only reimburse the facility when the procedure is performed on an inpatient. CMS updates the list each year, adding or deleting procedures. Facilities face two problems: CMS uses CPT® codes to identify inpatient-only procedures and the updates are published in the OPPS proposed and final rules.
Inpatient coders and billers don't use CPT codes, so they may not be aware that CMS considers a procedure inpatient only. Also, HIM staff on the inpatient side of the facility may not read the outpatient rule.
Some procedures on the inpatient-only list make sense—a physician would never perform a double lung transplant with cardiopulmonary bypass (CPT code 32854) on an outpatient basis. However, coders should not automatically assume a procedure is on the inpatient-only list, says Beverly Cunningham, MS, RN, vice president of resource management at Medical City Dallas Hospital. "This is not an intuitive process."
Continue reading "Review and reevaluate the process for identifying inpatient-only procedures" on the HCPro website. Subscribers to Briefings on Coding Compliance Strategieshave free access to this article in the July issue.

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