The action by CMS to remove total knee replacement from the inpatient-only was not unexpected in the 2018 OPPS final rule released on Wednesday.
In a surprised move the Centers for Medicare and Medicaid Services (CMS) released the Outpatient Prospective Payment System (OPPS) final rule Wednesday rather than on Friday as the agency has done in the past. But as expected, CMS did finalize their proposal to remove total knee replacement from the inpatient-only list.
Unfortunately, CMS did not provide any useful guidance on how a physician should determine which patients qualify for inpatient admission, referencing instead their standard statement that it “is a complex medical judgment made by the physician based on the beneficiary’s individual clinical needs and preferences.”
CMS also removed laparoscopic and robotic prostatectomy from the list, as the agency had proposed but also, unexpectedly, removed four gastric laparoscopic procedures CPT® 43282, 43772, 43773, 43774.
Even more surprisingly, and with little comment, CMS added CPT 92941, Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, to the inpatient-only list. This move should provide hospitals that treat patients with acute myocardial infarctions very efficiently with a bit of relief knowing that they can always be admitted as inpatient.
Additional updates to follow.
As I continue to focus on documentation, this week I am turning my attention to a frequently misunderstood Medicare rule: the Three-Day Payment Window. This
Radiology reports are rich with clinical detail—abnormalities, precise anatomy, and incidental findings—but that level of detail doesn’t always translate cleanly into ICD-10 coding. In my
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