Health Information Management

Q&A: Have any procedures been added or removed from the inpatient-only list?

APCs Insider, December 19, 2014

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Q: Did CMS make any changes to the inpatient-only list? Usually there is a lot of discussion about it but I haven’t heard anything.
 
A: CMS made some changes to the inpatient-only list for 2015. As it does each year, CMS read comments and recommendations from the public and internally regarding procedures that should be included on or removed from the list.
 
The inpatient-only list includes the codes that CMS determines through a process review are only safely performed in the inpatient setting for Medicare beneficiaries. CMS does not reimburse for the procedures unless performed in the inpatient setting.
 
Two codes were removed from the list:
  • 63043, laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional cervical interspace
  • 63044, laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional lumbar interspace
 
The laminotomy codes are add-on codes and assigned to status indicator N (no additional payment, payment included in line items with APCs for incidental service) under the OPPS. CMS will not provide extra reimbursement, but will no longer consider the procedure to be inpatient-only.
 
CMS added CPT code 22222 (osteotomy of spine, including discectomy, anterior approach, single vertebral segment; thoracic) to the inpatient-only list beginning January 1, 2015.
 
A full listing of procedures included on the inpatient-only list is located in Addendum E of the OPPS.
 
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Florida, answered this question.



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