Q&A: Identifying Inpatient-Only Procedures

Q: How are inpatient-only procedures identified?

A: An inpatient-only procedure is one that CMS has determined can only be safely performed on an inpatient basis because of (CMS, 2016: Chapter 4, Section 180.7):

• The invasive nature of the procedure
• The need for at least 24 hours of postoperative recovery time or monitoring before the patient can be discharged
• The underlying physical condition of the patient

CMS reviews the inpatient-only list during the annual OPPS rulemaking process, adding or removing procedures from the inpatient-only list at that time. During this review process, new procedures are examined for possible inclusion on the inpatient-only list, and procedures on the existing list are considered for removal. Procedures can be removed if:

• Most outpatient surgery departments are able and equipped to provide the service
• The simplest procedure defined by the code is permitted to be performed on an outpatient
• The procedure is related to codes that have been removed from the inpatient-only list
• CMS determines that the procedure is being successfully performed on outpatients in many hospitals

For more information, refer to the Inpatient-Only Procedures Training Handbook.

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