Healthcare Insights
Top Medicare and All-Payer Inpatient Procedures by ICD-10 Code
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
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ICD-10 Code | Description | Number of Procedures | ICD-9 Code | Explore These Claims | |
1. | 3E0234Z | Introduction of Serum, Toxoid and Vaccine into Muscle | 1,920,679 | 9955 | Explore This Code |
2. | 02HV33Z | Insertion of Infusion Device into Superior Vena Cava | 1,657,273 | 3893 | Explore This Code |
3. | 10E0XZZ | Delivery of Products of Conception | 1,603,965 | 7359 | Explore This Code |
4. | 30233N1 | Transfusion of Nonautologous Red Blood Cells into Peripheral Vein | 1,561,080 | 9904 | Explore This Code |
5. | 3E0G76Z | Introduction of Nutritional Substance into Upper GI, Via Natural or Artificial Opening | 1,466,731 | 9635 | Explore This Code |
6. | 10D00Z1 | Extraction of Products of Conception, Low Cervical, Open Approach | 1,018,125 | 0741 | Explore This Code |
7. | 4A023N7 | Measurement of Cardiac Sampling and Pressure, Left Heart | 959,965 | 3722 | Explore This Code |
8. | B2111ZZ | Fluoroscopy of Multiple Coronary Arteries using Low Osmolar Contrast | 950,638 | 8856 | Explore This Code |
9. | 0BH17EZ | Insertion of Endotracheal Airway into Trachea, Via Natural or Artificial Opening | 910,424 | 9604 | Explore This Code |
10. | 5A1D60Z | Performance of Urinary Filtration, Multiple | 745,271 | 3995 | Explore This Code |
11. | B2151ZZ | Fluoroscopy of Left Heart using Low Osmolar Contrast | 634,378 | 8853 | Explore This Code |
12. | 10907ZC | Drainage of Amniotic Fluid, Therapeutic from Products of Conception, Via Natural or Artificial Opening | 564,513 | 7309 | Explore This Code |
13. | 5A1945Z | Respiratory Ventilation, 24-96 Consecutive Hours | 541,962 | 9671 | Explore This Code |
14. | 0DJ08ZZ | Inspection of Upper Intestinal Tract, Via Natural or Artificial Opening Endoscopic | 495,048 | 4513 | Explore This Code |
15. | 5A1955Z | Respiratory Ventilation, Greater than 96 Consecutive Hours | 479,982 | 9672 | Explore This Code |
16. | 0DB68ZX | Excision of Stomach, Via Natural or Artificial Opening Endoscopic, Diagnostic | 462,155 | 4516 | Explore This Code |
17. | 5A09357 | Assistance with Respiratory Ventilation, Less than 24 Consecutive Hours, Continuous Positive Airway Pressure | 461,567 | 9390 | Explore This Code |
18. | HZ2ZZZZ | Detoxification Services for Substance Abuse Treatment | 435,023 | 9462 | Explore This Code |
19. | 0SRC0J9 | Replacement of Right Knee Joint with Synthetic Substitute,Cemented, Open Approach | 419,586 | 8154 | Explore This Code |
20. | 0SRD0J9 | Replacement of Left Knee Joint with Synthetic Substitute, Cemented, Open Approach | 391,165 | 8154 | Explore This Code |
21. | B548ZZA | Ultrasonography of Superior Vena Cava, Guidance | 351,487 | 0028 | Explore This Code |
22. | 0FT44ZZ | Resection of Gallbladder, Percutaneous Endoscopic Approach | 336,183 | 5123 | Explore This Code |
23. | 5A1935Z | Respiratory Ventilation, Less than 24 Consecutive Hours | 336,005 | 9671 | Explore This Code |
24. | 009U3ZX | Drainage of Spinal Canal, Diagnostic | 318,752 | 0331 | Explore This Code |
25. | 027034Z | Dilation of Coronary Artery, One Artery with Drug-eluting Intraluminal Device, Percutaneous Approach | 298,176 | 0066 | Explore This Code |
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
Definitive's Healthcare Insights are developed with data from the Definitive Healthcare platform. Want even more insights? Start a Free Trial now and get access to the highest quality data and intelligence on hospitals, physicians, and other healthcare providers.
ICD-10 Code | Description | Number of Procedures | ICD-9 Code | Explore These Claims | |
1. | 30233N1 | Transfusion of Nonautologous Red Blood Cells into Peripheral Vein | 641,011 | 9904 | Explore This Code |
2. | 02HV33Z | Insertion of Infusion Device into Superior Vena Cava | 620,957 | 3893 | Explore This Code |
3. | 5A1D60Z | Performance of Urinary Filtration, Multiple | 385,161 | 3995 | Explore This Code |
4. | B2111ZZ | Fluoroscopy of Multiple Coronary Arteries using Low Osmolar Contrast | 357,021 | 8856 | Explore This Code |
5. | 4A023N7 | Measurement of Cardiac Sampling and Pressure, Left Heart | 343,044 | 3722 | Explore This Code |
6. | 0BH17EZ | Insertion of Endotracheal Airway into Trachea, Via Natural or Artificial Opening | 313,946 | 9604 | Explore This Code |
7. | B2151ZZ | Fluoroscopy of Left Heart using Low Osmolar Contrast | 221,174 | 8853 | Explore This Code |
8. | 0DJ08ZZ | Inspection of Upper Intestinal Tract, Via Natural or Artificial Opening Endoscopic | 196,493 | 4513 | Explore This Code |
9. | 5A09357 | Assistance with Respiratory Ventilation, Less than 24 Consecutive Hours, Continuous Positive Airway Pressure | 190,377 | 9390 | Explore This Code |
10. | 5A1945Z | Respiratory Ventilation, 24-96 Consecutive Hours | 190,198 | 9671 | Explore This Code |
11. | 0DB68ZX | Excision of Stomach, Via Natural or Artificial Opening Endoscopic, Diagnostic | 177,121 | 4516 | Explore This Code |
12. | 5A1955Z | Respiratory Ventilation, Greater than 96 Consecutive Hours | 171,179 | 9672 | Explore This Code |
13. | 0SRC0J9 | Replacement of Right Knee Joint with Synthetic Substitute, Cemented, Open Approach | 170,376 | 8154 | Explore This Code |
14. | 0SRD0J9 | Replacement of Left Knee Joint with Synthetic Substitute, Cemented, Open Approach | 158,600 | 8154 | Explore This Code |
15. | B548ZZA | Ultrasonography of Superior Vena Cava | 156,170 | 0028 | Explore This Code |
16. | 5A1D00Z | Performance of Urinary Filtration, Single | 148,607 | 3995 | Explore This Code |
17. | 0DJD8ZZ | Inspection of Lower Intestinal Tract, Via Natural or Artificial Opening Endoscopic | 122,498 | 4523 | Explore This Code |
18. | 5A1935Z | Respiratory Ventilation, Less than 24 Consecutive Hours | 116,512 | 9671 | Explore This Code |
19. | 027034Z | Dilation of Coronary Artery, One Artery with Drug-eluting Intraluminal Device | 107,671 | 0066 | Explore This Code |
20. | 5A1221Z | Performance of Cardiac Output, Continuous | 104,158 | 3961 | Explore This Code |
21. | 3E0234Z | Introduction of Serum, Toxoid and Vaccine into Muscle | 99,461 | 9955 | Explore This Code |
22. | 05HM33Z | Insertion of Infusion Device into Right Internal Jugular Vein | 92,494 | 3893 | Explore This Code |
23. | 5A2204Z | Restoration of Cardiac Rhythm, Single | 90,458 | 9962 | Explore This Code |
24. | 5A09457 | Assistance with Respiratory Ventilation, 24-96 Consecutive Hours, Continuous Positive Airway Pressure | 79,994 | 9390 | Explore This Code |
25. | 0DH63UZ | Insertion of Feeding Device into Stomach, Percutaneous Approach | 79,022 | 4311 | Explore This Code |
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.