Procedures removed from the inpatient only list

Effective for the calendar (CY) 2018, several procedures will be removed from the inpatient only list. These procedures are listed in the table below. CPT Code Long Descriptor 27447 Arthroplasty, knee, condyle and plateau; medical and lateral compartments with or without patella resurfacing (total knee arthroplasty) 43282 Laparoscopy, surgical, repair of paraesophageal hernia with implantation of mesh 43772 Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device component only 43773 Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric restrictive device component only 43774 Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device...

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Note:  The following article synopsis was NOT provided by the AHA. It was created by Find-A-Code/innoviHealth.

Article Overview

This premium article reviews a 2018 Medicare update involving procedures removed from the inpatient-only list. It is relevant to hospital coders, outpatient facility staff, ASC teams, and billing professionals who need to understand the scope of the change and its implications for where services may be covered and paid. The discussion stays at a policy level and addresses inpatient versus outpatient hospital billing concepts, ASC inclusion status, and the general framework Medicare uses for surgical setting coverage.

Why This Topic Matters

Understanding when procedures move off the inpatient-only list helps coding and billing teams align claims with current Medicare coverage rules and setting-specific payment policies. It also helps facilities distinguish between hospital coverage and ASC payment status without relying on assumptions about site of service.

What You Will Learn

  • The Medicare context for procedures removed from the inpatient-only list
  • How the update relates to inpatient and outpatient hospital coverage
  • Why ASC payment status is discussed separately from hospital coverage
  • The kinds of general billing and setting considerations associated with the 2018 update

Who Should Read This

  • Hospital coders
  • Outpatient facility coders
  • ASC billing staff
  • Medicare reimbursement specialists
  • Revenue cycle professionals

Codes Discussed


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