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. 

Source Documents

Total Joint Replacement- Inpatient or Outpatient?

Professional Society Statements

Don't Forget Medical Necessity

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 

Copyright © Ronald Hirsch. All rights reserved. The opinions expressed and references posted are those of the author and do not necessarily reflect the views, policies, or opinions of R1 RCM, Inc. or R1  Physician Advisory Services (R1 PAS®). There is no guarantee that references have not been subsequently updated and are no longer valid. This web site was set up in about 30 minutes, using GoDaddy.com Web Builder. I am a better case management professional and doctor than I am a web site designer.

My interpretations of the Rule