My RACmonitor webinar on Total Knee Replacement Status determinations

CMS MLN Matters SE19002 V 2

TKA Status Determinations

AAOS Comment on 2021 OPPS Rule to Eliminate IOL

Total Joint Replacement- Inpatient or Outpatient?

All guidance in documents provided here is based on my  personal interpretation of the CMS regulations and information provided in the Federal Register and submissions from others. This does not represent R1 RCM, Inc. official policy or guarantee any results on audit or appeal. 

My interpretations of the Rule

Don't Forget Medical Necessity

Sample Admission Policy for TKR

Source Documents

Professional Society Statements

As of 2020, HCPCS 27130, total hip arthroplasty, is removed from the inpatient only list. All concepts discussed for TKA status determinations also apply to THA. Note that same day discharge patients, more common with THA, should always be outpatient. See disclaimer below 

AAHKS Position Statement on Status

AAOS TKA Status FAQ 1-31-18

SE 1236- Documenting Medical Necessity for Major Joint Replacement (Hip and Knee)

Another Sample Policy with References

Feb 28, 2017 Statement by AAOS on TKR Status

Inpatient Documentation Checklist

THA Commentary in 2020 OPPS Final Rule

TKR Commentary in

2018 OPPS Final Rule 

Rescinded version 

CMS MLN Matters SE 19002

Status Total Knee Arthroplasty