AHA Coding Clinic® for HCPCS - 2020 Quarter 1
Total hip arthroplasty removed from inpatient-only list
A patient with degenerative osteoarthritis complaining of severe pain and impaired function undergoes a left total hip replacement after getting no relief from conservative treatment including medication and physical therapy. How should this procedure be coded? Is a separate code needed for the prosthesis? ...
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Article Overview
This article covers a CMS update to the Medicare Inpatient Only List for calendar year 2020, with discussion of how total hip arthroplasty and related anesthesia are treated under the OPPS/ASC final rule. It is relevant to hospital outpatient, inpatient, and orthopedic coding professionals who need to understand the scope of the policy change, the CMS context, and the accompanying coding example involving procedure and implant reporting. The article also highlights how the Medicare policy discussion relates to patient selection considerations and annual review of the IPO list.
Why This Topic Matters
Understanding this CMS update helps coding and reimbursement staff recognize which hip arthroplasty services were removed from the inpatient-only list and how that affects hospital setting assignment. It also supports accurate code capture for the procedure and associated implant reporting in a total hip replacement case.
Article Sections
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CMS removal of total hip arthroplasty from the IPO List
This section describes the 2020 Medicare policy update and the general status of total hip arthroplasty and related anesthesia under the inpatient-only framework. It also notes which broader hip arthroplasty procedures remain subject to the list.
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IPO List background and annual review
This section explains what the inpatient-only list is, how CMS uses it, and where it appears in the annual rulemaking process. It places the policy change in the context of the OPPS/ASC final rule.
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CMS discussion of outpatient candidate considerations
This section summarizes the broad factors CMS discusses when considering whether a patient may be appropriate for an outpatient hip arthroplasty setting. It contrasts general patient characteristics and clinical circumstances without providing selection rules.
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Coding example: total hip replacement and prosthesis reporting
This section presents a coding scenario for a total hip replacement and addresses whether an additional code is needed for the implant. It also references HCPCS Level II reporting for the prosthesis in the example.
What You Will Learn
- How CMS updated the inpatient-only status for total hip arthroplasty in calendar year 2020
- How the article situates hip arthroplasty within the Medicare OPPS/ASC final rule process
- What broad considerations CMS discusses for outpatient versus inpatient hip arthroplasty settings
- How the article frames coding and implant reporting for a total hip replacement case
Who Should Read This
- Hospital coders
- Outpatient coding staff
- Inpatient coding staff
- Orthopedic coding specialists
- Revenue cycle professionals
- Compliance staff
Codes Discussed
Code Ranges Discussed
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