When submitting total hip arthroplasty (THA) and total knee arthroplasty (TKA) requests, it is imperative that you select the appropriate level of care (i.e., inpatient or outpatient). This applies to the following procedures:
TKA, codes 27446 and 27447
THA, code 27130
According to the CMS guidelines, if patients are not expected to stay two (2) midnights or more at the designated facility, then the request should NOT be designated as an inpatient stay, and should instead be submitted as an outpatient request.
To ensure that patients are receiving the best possible care, please only select inpatient level of care for patients who will be staying at the facility for two (2) or more midnights. Inpatient care requests will be reviewed by a team of clinicians to ensure criteria is met for the stay. If you have any questions about this update, you can view the CMS guideline here.