[
Effective January 1, 2014, based on local practice
patterns, IBC will consider the procedures listed below
to be outpatient procedures, as they are being performed
mainly in the outpatient setting and generally no longer
require inpatient hospitalization.
The following is a list of procedures that will be considered
outpatient procedures for dates of service on or after
January 1, 2014:
- thyroidectomy — partial or total
- parathyroidectomy
- recurrent hernia
- temporomandibular joint (TMJ) arthroplasty and
discectomy
- arthroscopy (shoulder, elbow, wrist)
- open reduction internal fixation of uncomplicated wrist
or finger fractures
We ask that providers perform these procedures as
outpatient; however, if you feel there are medical reasons
that would justify an inpatient stay, IBC will review
these upon request and approve the inpatient setting if
medically appropriate. If we approve these procedures as
inpatient and the patient goes home the same day, we will
reimburse these procedures as outpatient. You may direct
your review requests to the Precertification Department by
calling 1-800-ASK-BLUE and saying
Authorizations.
Please note that as of January 1, 2014, none of the
procedures listed above will require precertification if
performed in the outpatient setting.
If you have any questions about this notice or criteria
for the above procedures, please contact Pamela
Weatherbee, Manager of Care Management Coordination,
at 215-241-9449.