Wiki 63040 outpatient/inpatient ????

[RebeccaWoodward*]

Hi Gang~

Well...I find myself in unfamiliar territory. CPT code 63040 is not deemed an inpatient procedure on the "inpatient hospital list"; however, the "add on" code, 63043, is considered to be an inpatient procedure. Here's the dilemma. Our surgeons have given orders for 63040 as outpatient. While in surgery, the surgeon determines that an additional level on the spine needs repair (63043). One code is outpatient (63040) and one is deemed inpatient (63043). This is causing some conflict; as you can see. I've been advised from previous colleagues to appeal the POS; which I will. My question....why is the add-on code considered as an inpatient procedure when the parent code is not?? I'm still still researching this...but I thought someone may have encountered this same scenerio. Thoughts?

 

[mbort]

my thoughts: perhaps because more than one level then supercedes the medicare rules regarding 90 minute surgery, etc.????

 

[RebeccaWoodward*]

Thanks Mary. I was surprised by the lack of information I could get on this. I did find something about the 90 minute rule but it appears to appy to ASC's only. Am I correct?

 

[mbort]

Was the procedure performed at an ASC or done as an outpatient at a hospital facility? The same rules very well may apply but I'm really not sure on that one.

 

[RebeccaWoodward*]

It was done outpatient but the orders had to be changed to inpatient since an additional level was performed.