Corporate Compliance

Inpatient-only procedure list

Compliance Monitor, September 23, 2005

Q: How can we better comply with the inpatient-only procedure list? I understand changes were made in the OPPS final rule for 2005, and I'm concerned about denied claims.

A: CMS updated the inpatient-only procedure list in its OPPS final rule. This information is in Addendum E of the rule. Although the agency did not add any new procedures to the list, it did remove 22, including codes 00174 (anesthesia, pharyngeal surgery) and 00928 (anesthesia, removal of testis), which had a status indicator of N, meaning no reimbursement.

The remaining 20 removed from the list had a status indicator of T, referring to surgical procedures.

Look at this new list of procedures so your facility knows what it can and can't perform on an outpatient basis and how you should bill these services. Place your outpatient CPT codes on the surgery schedule to eliminate the risk of providing inpatient procedures on an outpatient visit. If you bill patients as "inpatient" who do not fit the criteria, Medicare may deny the claim.

For more information about the inpatient v. outpatient changes, refer to Transmittal 229 titled "Inpatient Admissions Change to Outpatient," issued September 10, 2004.

Editor's note: This information is from Log on to learn more about HCPro, Inc.'s newest resource for coders.

Most Popular