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2006 INPATIENT ONLY PROCEDURES
The Inpatient Only List specifies those services that are only paid when provided in an inpatient setting for a Medicare beneficiary because of: the nature of the procedure, the need for at least 24 hours of post-operative recovery time or monitoring before the patient can be safely discharged, or the underlying physical condition of the patient.
Even though some believe the Inpatient Only List should be eliminated, CMS continues to believe that there are services that cannot be safely and effectively delivered to Medicare beneficiaries in a hospital outpatient setting. In addition CMS believes that eliminating the Inpatient Only List could result in unsafe care for Medicare beneficiaries.
CMS also states that the absence of a procedure from the Inpatient Only List should not be interpreted as identifying those procedures, which would only be performed in an outpatient setting. When a procedure is not listed on the Inpatient Only List it is the practitioner’s judgment to determine whether a particular procedure is more appropriately performed in an inpatient setting.
The determination for an “inpatient only” procedure is made by CMS for Medicare only. The same procedures may be performed on an outpatient basis for patients with another payer.
There are 26 procedures removed from the Inpatient Only List effective January 1, 2006. They are listed below:
| HCPCS |
Long Descriptor |
New
APC
Assignment |
Old
Status
Indicator |
New
Status
Indicator |
| 00634 |
Anesthesia for procedures in lumbar region;
chemonucleolysis |
N/A |
C |
N |
| 01190 |
Anesthesia for obturator neurectomy; intrapelvic |
N/A |
C |
N |
| 20662 |
Application of halo, including removal; pelvic |
0049 |
C |
T |
| 20663 |
Application of halo, including removal; femoral |
0049 |
C |
T |
| 20822 |
Replantation, digit, excluding thumb (includes distal tip to sublimis tendon insertion), complete amputation |
0054 |
C |
T |
| 20972 |
Free osteocutaneous flap with microvascular anastomosis; metatarsal |
0056 |
C |
T |
| 20973 |
Free osteocutaneous flap with microvascular anastomosis; great toe with web space |
0056 |
C |
T |
| 21150 |
Reconstruction midface, lefort II; anterior intrusion (e.g., treacher-collins syndrome) |
0256 |
C |
T |
| 21175 |
Reconstruction, bifrontal, superior-lateral orbital, rims and lower forehead, advancement or alteration (e.g.,
plagiocephaly, trigonocephaly, brachycephaly), with or without grafts (includes obtaining
autografts) |
0256 |
C |
T |
| 21195 |
Reconstruction of mandibular rami and/or body, sagittal
split; without internal rigid fixation |
0256 |
C |
T |
| 21408 |
Open treatment of fracture of orbit, except blowout; with bone grafting (includes obtaining graft) |
0256 |
C |
T |
| 21495 |
Open treatment of hyoid fracture |
0253 |
C |
T |
| 27475 |
Arrest, epiphyseal, any method (e.g., epiphysiodesis); distal femur |
0050 |
C |
T |
| 31293 |
Nasal/sinus endoscopy, surgical; with medial orbital wall and inferior orbital wall decompression |
0075 |
C |
T |
| 31294 |
Nasal/sinus endoscopy, surgical; with optic nerve decompression |
0075 |
C |
T |
| 36510 |
Catheterization of umbilical vein for diagnosis or therapy, newborn |
N/A |
C |
T |
| 37183 |
Remove hepatic shunt (tips) |
0229 |
C |
T |
| 37195 |
Thrombolysis, cerebral, by intravenous infusion |
0676 |
C |
T |
| 54560 |
Exploration for undescended testis with abdominal exploration |
0183 |
C |
T |
| 55600 |
Vesiculotomy |
0183 |
C |
T |
| 59100 |
Hysterotomy, abdominal (e.g., for hydatidiform mole, abortion) |
0195 |
C |
T |
| 61334 |
Exploration of orbit (transcranial approach); with removal of foreign body |
0256 |
C |
T |
| 62160 |
Neuroendoscopy |
0122 |
C |
T |
| 63075 |
Diskectomy, anterior, with decompression of spinal cord and/or nerve
root(s), including osteophytectomy; cervical, single interspace |
0208 |
C |
T |
| 64763 |
Transection or avulsion of obturator nerve, extrapelvic, with or without adductor tenotomy |
0220 |
C |
T |
| 64766 |
Transection or avulsion of obturator nerve, intrapelvic, with or without adductor tenotomy |
0221 |
C |
T |
Complete list of 2006 Inpatient Only
Procedures
It is recommended that the entire list be reviewed and revised to include only those procedures performed at your facility. The revised hospital specific list should be available to those staff involved in registering or scheduling surgical procedures (i.e., scheduling, registration, pre-admission testing, etc.) at your facility. Surgeons and their office staff may find this list valuable also.
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