Professional Society Statements

Don't Forget Medical Necessity

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

Source Documents

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