July I/OCE update: Payment for anesthesia packaged with payment for TKA under OPPS

CMS introduced packaging guidance for total knee arthroplasty (TKA) procedures paid under the OPPS and billed in conjunction with anesthesia administration as part of the July 2018 quarterly update to the integrated outpatient code editor (I/OCE).

In the 2018 OPPS final rule, effective January 1, CMS removed TKA from the Medicare Inpatient-Only (IPO) list, which specifies procedures that are typically only provided in the inpatient setting and therefore not paid under the OPPS. The July update specifies how outpatient facilities should report TKA administered with anesthesia on claims submitted after this revision was made.

Effective retroactively for claims submitted on or after January 1, 2018, when CPT code 01402 (anesthesia for open or surgical arthroscopic procedures on knee joint; total knee arthroplasty) for anesthesia is billed with code 27447 (arthroplasty, knee, condyle and plateau; medical and lateral compartments with or without patella resurfacing [total knee arthroplasty]) for a TKA procedure, payment for the anesthesia is packaged into the payment for the TKA.

Code 01402 has been assigned status indicator C (inpatient procedure; not paid under OPPS) and will only be paid on an outpatient when reporting with code 27447.

Review all of the July OPPS updates in Transmittal 4064.