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We all have experienced Medicare denials for procedures performed outpatient when they are on Medicare’s list for inpatient only. This seems counter intuitive at times, but the rules are followed and processes need to be put in place to prevent lost reimbursement. While best to have the inpatient order assigned before the procedure, Medicare now allows the inpatient order to be written before discharge. Also, please note that you may still send the patient home the same day, however, the physician order must reflect inpatient.

Below is a summary of 2017’s changes noted when compared to the 2016 listing:

The following procedures were removed due to a discontinued code (SI=D):

33400 Repair of aortic valve  DISCONTINUED CODE
33401 Valvuloplasty open   DISCONTINUED CODE
33403 Valvuloplasty w/cp bypass  DISCONTINUED CODE
35450 Repair arterial blockage  DISCONTINUED CODE
35452 Repair arterial blockage   DISCONTINUED CODE

The following procedures were removed from the list and may be performed outpatient:

 

0169T Place stereo cath brain
0281T Laa closure w/implant
22585 Additional spinal fusion
22840 Insert spine fixation device
22842 Insert spine fixation device
22845 Insert spine fixation device
22858 Second level cer diskectomy
27477 Surgery to stop leg growth
27485 Surgery to stop leg growth
31584 Treat larynx fracture
31587 Revision of larynx
33400 Repair of aortic valve
33401 Valvuloplasty open
33403 Valvuloplasty w/cp bypass
35450 Repair arterial blockage
35452 Repair arterial blockage
6164B Evasc prlng admn rx agnt 1st
6164C Evasc prlng admn rx agnt add

The following procedures were added to the inpatient only list:

0451T Insj/rplcmt aortic ventr sys
0452T Insj/rplcmt dev vasc seal
0455T Remvl aortic ventr cmpl sys
0456T Remvl aortic dev vasc seal
0459T Relocaj rplcmt aortic ventr
0461T Repos aortic contrpulsj dev
33340 Perq clsr tcat l atr apndge
33390 Valvuloplasty aortic valve
33391 Valvuloplasty aortic valve
61645 Perq art m-thrombect &/nfs
61650 Evasc prlng admn rx agnt 1st
61651 Evasc prlng admn rx agnt add

And, the following procedures are the same, however, a slightly different code: 

2017 2016
33477 Implant tcat pulm vlv perq 3347A Implant tcat pulm vlv perq
54438 Replantation of penis 5443B Replantation of penis