The Conundrum Presented by Outpatient Surgeries

by  Mary Beth Pace, RN, BSN, MBA, ACM, CMAC
May 13th, 2022

Do you keep them under inpatient status? Or do you bring them in as outpatients and just keep them overnight? 

For our Medicare populations, in all of our organizations, the ability to follow the CPT code of the applicable surgical procedure is the determining factor to bill inpatient surgeries correctly. We are probably not alone in that, over the years, a few patients have had surgery and were discharged from the recovery area, only to find out later that the procedure included a CPT code on the inpatient-only list. This happens because not all of the team members involved speak in coding language. It is a pretty significant loss when you cannot recuperate the costs of those cases.

On the other side of that coin, those patients who are brought in for an outpatient procedure that we provide care for overnight can be just as big of a financial drain on your system. And while I always advocate for doing what is right for the patient in your care, we all know that getting reimbursed for that care is tantamount to keeping your doors open for the next patient.


Read the entire article at RACmonitor by clicking here.

This article originally published on May 11, 2022 by RACmonitor.


The Conundrum Presented by Outpatient Surgeries. (2022, May 13). Find-A-Code Articles. Retrieved from

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