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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.