Defining Ambulatory Surgery: Responses from the Listserv

Outpatient surgery(OP)is defined as invasive or non-invasive procedures requiring any form of anesthetic, performed on the same day scheduled, or in rare instances when there are complications, requiring an overnight stay.

rra1@columbia.edu [mailto:rra1@columbia.edu]

Currently, we at the Office of Health Care Statistics, Utah Department of Health, define inpatients as patients that spend at least one night (or at least 24 hours) in the hospital/facility and outpatients as patients that do not spend the night (or less than 24 hours) in the hospital/ facility.  However, during a recent consultation with medical specialists who perform laparoscopic gallbladder removal, we have learned that hospitals do not always distinguish inpatients and outpatients this way.  Sometimes "outpatients" remain in the hospital overnight (or longer than 24 hours) for "observation."  Or an outpatient who is scheduled for a surgery or procedure late in the day may stay overnight.  We find a few cases among about a quarter of a million "outpatient" discharges annually that have lengths of stay longer than one calendar day and that apparently were not admitted as "inpatients."

In our National Survey of Ambulatory Survey, we collect information on surgical and nonsurgical procedures performed on an outpatient basis in a hospital or freestanding ambulatory surgery center’s general operating rooms, and other specialized rooms such as endoscopy units and cardiac catheterization labs. Does this help? -cb

Burt, Catharine W. (CDC/CCHIS/NCHS) [mailto:cwb2@cdc.gov]

Ambulatory surgery refers to surgical and nonsurgical procedures performed on an outpatient basis in a hospital or freestanding ambulatory surgery center’s general operating rooms, and other specialized rooms such as endoscopy units and cardiac catheterization labs.

Financial Monitoring And Reporting Regulations

3. Had a normal discharge, for example, was not transferred, did not leave AMA, and was not discharged dead.

Missouri's definition, such as it is, is part of our definition for outpatient encounters--'Outpatient encounters means patients seen in the emergency room, patients receiving invasive procedures on an outpatient basis--CPT codes 10000-69999 and ICD-9-CM codes 01.0-86.99, inclusive--and patients receiving selected services and procedures as defined in Exhibit A of this rule.' This is probably not too helpful. I can mail you Exhibit A if you think it would help. Let me know if you have any questions.

"The collection of outpatient data since the late 1980's in Vermont has been an iterative process. Until 2001, we let the hospitals define it and only specified that it occur in an operating room. In 2001, we started to specify an ICD-9-CM code range that includes most procedures that would be considered surgical, but stopped specifying the setting in order to get records for procedures occurring outside of operating rooms. Starting with the first record for 2006, we requested the hospitals to send us "everything outpatient" that occurs in any setting for which a hospital can provide outpatient services and more than doubled the records. This is getting us more records for diagnostic procedures and treatments which are growth areas. This leaves the definition for outpatient surgery up to the data users and how they want to cut the data based on procedure codes and in some cases- revenue codes. Revenue codes are much more complex, but can help you flag things based on location of service and nature of service."

Outpatient Surgeries are usually those provided to patients that tend to be invasive in nature such as biopsies, repairs, laparoscopy & endoscopy. Outpatient surgeries are items found in the CPT manual that are between the 10,000 and 69,999 range.

For more specific information, you may want to review the AMA CPT 2007 manual or the ICD 9 CM, Volume 3, 2007 Manual.

non-surgical) and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization."

Would that be a sufficient definition.  The problem I see with the definition below is that you would really never know what you should be receiving.  Every provider could define outpatient hospital substantially different?

I'm hoping to get HCUP's help too to come up with something reliable.  NAHDO may be interested; I can keep you abreast.

Here in Illinois our state is currently finalizing new data reporting requirements.  Our anticipated new Outpatient Surgical procedure ranges are below.  They are currently considered "proposed" and are therefore still subject to change pending final rules from the State of Illinois.  Per the information we have at this time, we will begin collecting Outpatient Surgeries using this new range beginning with 01/01/08 discharges. 

Invasive Procedures: 70010 – 76499; 77401 – 77416; 77520 – 77525; 78000 – 78999; 79000 – 79999; 92970 – 92997; 93000 – 93278; 93303 – 93350; 93501 – 93652; 99217 – 99220; 99281 - 99288

http://www.health.state.ny.us/statistics/sparcs/amb_surg/definition.htm

From: Brian J. Balicki [mailto:bbalicki@shs.net]

There are at least two sources of information that could be used to define outpatient surgeries, particularly if the subject data is to be used for any comparison to national data sources – such as the new national survey on ambulatory surgery. From a policy research perspective, any procedures that appear on Medicare’s list of approved outpatient procedures for payment purposes, might be a source of “definition”.  In this case, the list itself would be the de facto definition of “outpatient surgery”.  

A second option might be to use the definition of “outpatient surgery” adopted by the National Center for Health Statistics, CDC, for its national survey of ambulatory surgery.   The link is here, http://www.cdc.gov/nchs/nsas.htm#what  .

Some states (FL for example) define Ambulatory Surgery as a range of CPT codes. From their website: “AS reportable events include those with a procedure that involves a valid Current Procedural Terminology (CPT) code occurring within the following ranges: 10000 through 69999, and 93500 through 93599”

Heath Umbach [mailto:HUmbach@webmd.net]