Insights

Bedside Physicians Do's and Don'ts


The Ensemble Physician Advisory Team shares what you need to know about documenting patient status.

Do

Don't

IPO List* procedures must remain Inpatient
regardless of the length of stay

Don’t place patients in Observation status before

Outpatient surgery is performed (You are predicting complications)

Remember! As a general rule:

Elective Outpatient procedure with no complications
Outpatient Status

Emergent Outpatient procedure with complications;
LOS < 2 Midnights = Observation Status

Emergent Outpatient procedure with complications; 
LOS ≥ 2 Midnights = Inpatient Status

Don’t place post-operative patients in
Observation status unless complications arise

Get prior approval for all elective surgical procedures
when required by the payer

Routine recovery time does not equal Observation

Specify all procedures and CPT codes

Don’t use unspecified codes when scheduling
procedures or add on procedures

Update CPT codes and Operative notes ASAP for
unexpected changes in procedure e.g. conversion from 
a laparoscopic to an open procedure

Don’t copy and paste

• IPO*(Inpatient Only) list created by Medicare includes high risk procedures that must be done in a hospital setting where all specialties are available if needed.

• IPO procedures cannot be done in an office or ambulatory surgical center (ASC).

• For questions about hospitalization status call your Ensemble physician advisor.

These materials are for general informational purposes only. These materials do not, and are not intended to, constitute legal or compliance advice, and you should not act or refrain from acting based on any information provided in these materials. Please consult with your own legal counsel or compliance professional regards specific legal or compliance questions you have.

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