inpatient and outpatient Medicare rules

On, coding 911, it has been brought up that Medicare requires admit to inpatient for patients that have open appendectomies performed...I have never been aware of that..Is this true?

open appendectomy is an inpatient only procedure

44950 Appendectomy

44955 Appendectomy when done for indicated purpose...

44960 Appendectomy for ruptured appendix...



All of these codes are inpatient-only....44970 which is laparoscopic appendectomy is not on CMS's inpatient only procedure list.

Christina

Medicare Inpatient vs Outpatient Procedures

Medicare has what are known as Status "C" procedures, which are listed in the Federal Register. There are aboiut 1600 procedures on the list. These are reimbursable to a hospital only if done as inpatient. Physician choice to perform as outpatient is not relevant. The hospital will write off the charges unless reported on bill type 111 with at least 1 day of room & care. Procedures on the list are selected based upon a patient having the procedure needing at least 24 hours of post-op monitoring, or that reason for the procedure would indicate at least 24 hours of post-op monitoring. If the claim is submitted as outpatient, it is a technical denial. The hospital cannot resubmit as inpatient. There are a couple of situations which will overide the system edits. 1. Patient expires in surgery before admit process is complete. 2. Procedure is done for emergency stabilization. Both situations will require detailed documentation and appending modifier CA to the procedure service line. Since physicians are not affected by this rule for reimbursement, hospitals that are diligent about revenue will educate their physician staff about this requirement.