AHA Coding Clinic® for HCPCS - 2023 Quarter 1; In This Issue
Changes to Medicare's Inpatient Only List for CY2023
As previously reported in Coding Clinic for HCPCS Fourth Quarter 2021, the Centers for Medicare and Medicaid Services (CMS) reversed its decision to eliminate the Inpatient Only List (IPO) in CY2022. Following the reversal, the IPO list is updated annually. For CY2023, eleven codes were removed and eight codes were added to the list. Of the eleven codes removed from the IPO list for CY2023, ten are in the musculoskeletal section of CPT. Nine of the ten are related to facial bone reconstructions, and/or repairs of facial bone fractures (e.g., Lefort reconstructions, malar fractures). The tenth is...
Subscribe or sign in to view the full article.
Article Overview
This article explains the CY2023 Medicare Inpatient Only List update and places it in the context of CMS hospital payment policy. It is relevant for hospital outpatient coders, inpatient coding staff, reimbursement professionals, and compliance teams who need to track which procedure categories were added to or removed from the list and understand the general implications for Medicare coverage and setting-specific payment.
Why This Topic Matters
The Inpatient Only List affects whether Medicare reimburses certain procedures in the inpatient setting versus the hospital outpatient setting. Understanding annual changes helps coding and reimbursement teams stay aligned with CMS policy and identify procedures that require special attention in facility billing workflows.
Article Sections
-
Overview of the CY2023 IPO update
Introduces the annual update process for the Medicare Inpatient Only List and summarizes the overall number of procedures removed and added for CY2023. It also explains the policy context for the list and its relevance to Medicare payment settings.
-
Removals from the Inpatient Only List
Describes the procedure groups removed from the list for CY2023 and organizes the removed items by broad clinical area. A table presents the affected CPT entries and the effective date of the change.
-
Additions to the Inpatient Only List
Describes the procedure groups added to the list for CY2023 and organizes the added items by broad clinical area. A table presents the affected CPT entries and the effective date of the change.
-
CMS guidance and related resources
Provides a brief reminder about how CMS uses the IPO list and points readers to a referenced CMS resource for the complete list of payable inpatient procedures.
What You Will Learn
- How the Medicare Inpatient Only List is updated for a new calendar year
- Which broad categories of procedures were removed from the list for CY2023
- Which broad categories of procedures were added to the list for CY2023
- How CMS describes the role of the Inpatient Only List in hospital payment policy
- Where to look for the referenced CMS addendum resource
Who Should Read This
- Hospital outpatient coders
- Inpatient coders
- Facility reimbursement staff
- Compliance staff
- Revenue cycle professionals
Codes Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com