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On January 1, the Centers for Medicaid and Medicare Services (CMS) released changes made to its list of inpatient-only procedures. Currently, there are approximately 1,700 surgical procedures on the list, with some being added and removed every year. One of the most notable—as well as controversial—adjustments this year is the removal of total knee arthroplasty, or knee replacements, from the inpatient-only list. The procedure can now be performed in an outpatient or inpatient setting.
A major implication of this change is that ambulatory surgery centers (ASCs) and other outpatient care centers can offer this procedure, potentially drawing patients and revenue away from more traditional hospital inpatient departments. One factor driving patients to ASCs for procedures, especially knee and hip replacements, is the cost difference. Hip replacements at an outpatient surgery center cost between $22–25,000. The same procedure at a hospital is around $40,000. Currently hip replacements are not covered by Medicare in an inpatient setting. The effects of a shift like this can’t be accurately predicted yet, as hospitals and health systems have acquired or partnered with ASCs and outpatient centers in anticipation of such events.
The following list features the top 25 all-payer and Medicare inpatient procedures by volume, with ICD-9 and ICD-10 codes. Injections, transfusions, and diagnostic tests dominated both lists, with “Insertion of Infusion Device into Superior Vena Cava” (ICD-10 code 02HV33Z) taking the number 2 spot on each. X-rays (fluoroscopy) were also prevalent in the all-payer and Medicare procedure lists.
Top 25 All-Payer Inpatient Procedures by ICD-10 Code
| ICD-10 Code | Description | Number of Procedures | ICD-9 Code | |
|
1. |
3E0234Z |
Introduction of Serum, Toxoid and Vaccine into Muscle |
1,920,679 |
9955 |
|
2. |
02HV33Z |
Insertion of Infusion Device into Superior Vena Cava |
1,657,273 |
3893 |
|
3. |
10E0XZZ |
Delivery of Products of Conception |
1,603,965 |
7359 |
|
4. |
30233N1 |
Transfusion of Nonautologous Red Blood Cells into Peripheral Vein |
1,561,080 |
9904 |
|
5. |
3E0G76Z |
Introduction of Nutritional Substance into Upper GI, Via Natural or Artificial Opening |
1,466,731 |
9635 |
|
6. |
10D00Z1 |
Extraction of Products of Conception, Low Cervical, Open Approach |
1,018,125 |
0741 |
|
7. |
4A023N7 |
Measurement of Cardiac Sampling and Pressure, Left Heart |
959,965 |
3722 |
|
8. |
B2111ZZ |
Fluoroscopy of Multiple Coronary Arteries using Low Osmolar Contrast |
950,638 |
8856 |
|
9. |
0BH17EZ |
Insertion of Endotracheal Airway into Trachea, Via Natural or Artificial Opening |
910,424 |
9604 |
|
10. |
5A1D60Z |
Performance of Urinary Filtration, Multiple |
745,271 |
3995 |
|
11. |
B2151ZZ |
Fluoroscopy of Left Heart using Low Osmolar Contrast |
634,378 |
8853 |
|
12. |
10907ZC |
Drainage of Amniotic Fluid, Therapeutic from Products of Conception, Via Natural or Artificial Opening |
564,513 |
7309 |
|
13. |
5A1945Z |
Respiratory Ventilation, 24-96 Consecutive Hours |
541,962 |
9671 |
|
14. |
0DJ08ZZ |
Inspection of Upper Intestinal Tract, Via Natural or Artificial Opening Endoscopic |
495,048 |
4513 |
|
15. |
5A1955Z |
Respiratory Ventilation, Greater than 96 Consecutive Hours |
479,982 |
9672 |
|
16. |
0DB68ZX |
Excision of Stomach, Via Natural or Artificial Opening Endoscopic, Diagnostic |
462,155 |
4516 |
|
17. |
5A09357 |
Assistance with Respiratory Ventilation, Less than 24 Consecutive Hours, Continuous Positive Airway Pressure |
461,567 |
9390 |
|
18. |
HZ2ZZZZ |
Detoxification Services for Substance Abuse Treatment |
435,023 |
9462 |
|
19. |
0SRC0J9 |
Replacement of Right Knee Joint with Synthetic Substitute,Cemented, Open Approach |
419,586 |
8154 |
|
20. |
0SRD0J9 |
Replacement of Left Knee Joint with Synthetic Substitute, Cemented, Open Approach |
391,165 |
8154 |
|
21. |
B548ZZA |
Ultrasonography of Superior Vena Cava, Guidance |
351,487 |
0028 |
|
22. |
0FT44ZZ |
Resection of Gallbladder, Percutaneous Endoscopic Approach |
336,183 |
5123 |
|
23. |
5A1935Z |
Respiratory Ventilation, Less than 24 Consecutive Hours |
336,005 |
9671 |
|
24. |
009U3ZX |
Drainage of Spinal Canal, Diagnostic |
318,752 |
0331 |
|
25. |
027034Z |
Dilation of Coronary Artery, One Artery with Drug-eluting Intraluminal Device, Percutaneous Approach |
298,176 |
0066 |
Fig 1. Data from Definitive Healthcare based on 2016 Medicare SAF data (most recent available), released in fall 2017. Calendar year 2017 data will be released in fall 2018.
Top 25 Medicare Inpatient Procedures by ICD-10 Code
| ICD-10 Code | Description | Number of Procedures | ICD-9 Code | |
|
1. |
30233N1 |
Transfusion of Nonautologous Red Blood Cells into Peripheral Vein |
641,011 |
9904 |
|
2. |
02HV33Z |
Insertion of Infusion Device into Superior Vena Cava |
620,957 |
3893 |
|
3. |
5A1D60Z |
Performance of Urinary Filtration, Multiple |
385,161 |
3995 |
|
4. |
B2111ZZ |
Fluoroscopy of Multiple Coronary Arteries using Low Osmolar Contrast |
357,021 |
8856 |
|
5. |
4A023N7 |
Measurement of Cardiac Sampling and Pressure, Left Heart |
343,044 |
3722 |
|
6. |
0BH17EZ |
Insertion of Endotracheal Airway into Trachea, Via Natural or Artificial Opening |
313,946 |
9604 |
|
7. |
B2151ZZ |
Fluoroscopy of Left Heart using Low Osmolar Contrast |
221,174 |
8853 |
|
8. |
0DJ08ZZ |
Inspection of Upper Intestinal Tract, Via Natural or Artificial Opening Endoscopic |
196,493 |
4513 |
|
9. |
5A09357 |
Assistance with Respiratory Ventilation, Less than 24 Consecutive Hours, Continuous Positive Airway Pressure |
190,377 |
9390 |
|
10. |
5A1945Z |
Respiratory Ventilation, 24-96 Consecutive Hours |
190,198 |
9671 |
|
11. |
0DB68ZX |
Excision of Stomach, Via Natural or Artificial Opening Endoscopic, Diagnostic |
177,121 |
4516 |
|
12. |
5A1955Z |
Respiratory Ventilation, Greater than 96 Consecutive Hours |
171,179 |
9672 |
|
13. |
0SRC0J9 |
Replacement of Right Knee Joint with Synthetic Substitute, Cemented, Open Approach |
170,376 |
8154 |
|
14. |
0SRD0J9 |
Replacement of Left Knee Joint with Synthetic Substitute, Cemented, Open Approach |
158,600 |
8154 |
|
15. |
B548ZZA |
Ultrasonography of Superior Vena Cava |
156,170 |
0028 |
|
16. |
5A1D00Z |
Performance of Urinary Filtration, Single |
148,607 |
3995 |
|
17. |
0DJD8ZZ |
Inspection of Lower Intestinal Tract, Via Natural or Artificial Opening Endoscopic |
122,498 |
4523 |
|
18. |
5A1935Z |
Respiratory Ventilation, Less than 24 Consecutive Hours |
116,512 |
9671 |
|
19. |
027034Z |
Dilation of Coronary Artery, One Artery with Drug-eluting Intraluminal Device |
107,671 |
0066 |
|
20. |
5A1221Z |
Performance of Cardiac Output, Continuous |
104,158 |
3961 |
|
21. |
3E0234Z |
Introduction of Serum, Toxoid and Vaccine into Muscle |
99,461 |
9955 |
|
22. |
05HM33Z |
Insertion of Infusion Device into Right Internal Jugular Vein |
92,494 |
3893 |
|
23. |
5A2204Z |
Restoration of Cardiac Rhythm, Single |
90,458 |
9962 |
|
24. |
5A09457 |
Assistance with Respiratory Ventilation, 24-96 Consecutive Hours, Continuous Positive Airway Pressure |
79,994 |
9390 |
|
25. |
0DH63UZ |
Insertion of Feeding Device into Stomach, Percutaneous Approach |
79,022 |
4311 |
Fig 2. Data from Definitive Healthcare based on 2016 Medicare SAF data (most recent available), released in fall 2017. Calendar year 2017 data will be released in fall 2018.