In the final rule for the outpatient prospective payment system (OPPS) for 2021, CMS announced plans to phase out the inpatient only list (IPO) by 2024. To kick that off, they removed 266 musculoskeletal-related services and their corresponding anesthesia services from the IPO list. Well, for 2022 most of those procedures are back on the IPO list along with an announcement that CMS is keeping the IPO list.
The IPO list is a list of services that Medicare will only pay for when performed in the inpatient setting because of the clinical complexity of the services and anticipation that the patient will remain in the hospital overnight. This includes obvious procedures, such as coronary artery bypass, as well as less invasive procedures, such as endovascular repair of an iliac aneurysm.
For 2022, CMS is adding back the services removed from the list in 2021, except for the following:
- 22630, Arthrodesis, posterior interbody technique, including laminectomy and/ or discectomy to prepare interspace (other than for decompression), single interspace; lumbar
- 23472, Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (for example, total shoulder)
- 27702, Arthroplasty, ankle; with implant (total ankle)
- 00630, Anesthesia for procedures in lumbar region; not otherwise specified
- 00670, Anesthesia for extensive spine and spinal cord procedures (e.g., spinal instrumentation or vascular procedures)
- 01638, Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; total shoulder replacement)
- 01486, Anesthesia for open procedures on bones of lower leg, ankle, and foot; total ankle replacement
Only one code is being added to the IPO list for CY 2022:
- 0643T, Transcatheter left ventricular restoration device implantation including right and left heart catheterization and left ventriculography when performed, arterial approach
In 2021, CMS also established a policy that would indefinitely exempt procedures removed from the IPO list from certain medical reviews associated with the two-midnight rule. This exemption was made because of the large number of procedures removed from the IPO list. Since most of those procedures are being added back to the IPO list for 2022, CMS is returning to the previous exemption period, which is two years.
Be sure to join us on December 16 for our last live webinar of 2021. In this presentation, Jen Cayce, RHIT, CCS, CCS-P, CPC will address the 2022 CPT code changes that affect facility outpatient coding.
Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer
Kristi also performs DRG and APC audits and is known for her vast knowledge on coding vascular interventional radiology procedures. Kristi has an extensive background in coding education and consulting and is a national speakers on topics related to ICD-10 and CPT coding as well as code-based reimbursement.