Outpatient Surgery and Related Procedures - INCLUSION

20.1.2.1 Outpatient Surgery and Related Procedures - INCLUSION (Rev. 3612, Issued: 09-16-16, Effective: 10-18-16, Implementation: 10-18-16) Inclusions, rather than exclusions, are given in this one case, because of the great number of surgical procedures that are excluded and can only be safely performed in a hospital operating room setting. It is easier to automate edits around the much shorter list of inclusions under this category, representing minor procedures (such as debriding a mycotic toenail) that, while technically considered “surgery,” can nevertheless be safely performed at bedside in the SNF itself. Additionally, this was the approach originally taken in the regulation to present this information. • Note that anesthesia, drugs, supplies and lab services will be bypassed by enforcement edits when billed with outpatient surgeries excluded from SNF CB. The bypass is implemented for these services when the line item date of service matches the line item date of service for the excluded surgery. For revenue codes not requiring a line item date of service (i.e., pharmacy and supplies), the bypass will be implemented when no line item date of service is present. See §10.1 above for the link to where transmittals providing current lists of HCPCS codes used for Major Category I SNF consolidated billing editing can be found.