Wiki Inpatient or Outpatient for CPT 63047?

[Erikou22]

Hi. I was hoping someone could offer some information in regards to CPT 63047/63048. The hospital is stating that these codes are outpatient, not inpatient and they are receiving denials. I would like feedback on how different practices schedule these surgeries please.

Any help would be greatly appreciated.

Sincerely,
Erika

 

[RebeccaCross*]

Typically, these are outpatient unless there is medical necessity to admit the patient. Per CMS:

Inpatient-Only Procedures

Hospitals are reminded that certain surgical procedures are payable under Medicare only when they are performed in the inpatient setting in accordance with the Fiscal Year (FY) 2014 Inpatient Prospective Payment System (IPPS) Final Rule CMS-1599-F. These procedures have been determined by CMS and published on the Inpatient- Only list. They have been designated as inpatient-only because of the nature of the procedure, the underlying physical condition of the patient, or the need for at least 24 hours of postoperative recovery time or monitoring before the patient can be safely discharged.

Below is the link to the "inpatient list" procedures (indicated by the letter "C")

http://www.cms.gov/apps/ama/license...tpatientPPS/Downloads/CMS-1601-FC-Addenda.zip

On the 1st row, click on the 4th addendum. This lists the codes that are deemed "inpatient only"...

On the 2nd row, click on the 1st addendum. This provides a breakdown of what each indicator stands for.

 

[Erikou22]

Thank you so much for your help!

Sincerely,
Erika K.