Clinical Policy Bulletin: Inpatient Admission Prior to Surgery (Preop Days)
Aetna considers inpatient hospital admission on days prior to surgery medically necessary when any of the following criteria is met:
A cardiac catheterization or a major surgical procedure scheduled within 24 hours for a child less than 1 year of age which requires intravenous fluids to achieve and maintain adequate hydration prior to the procedure; or
A planned major surgical procedure which requires an extensive bowel preparation (GoLytely, laxatives, multiple enemas) in a member with a co-morbidity (e.g., chronic renal failure, elderly individual with muscle wasting and poor nutritional status resulting in a significant weight loss of greater than 10 %) whose condition places the individual at high-risk for electrolyte and fluid imbalances; or
A planned surgical procedure on partially obstructed bowel which requires a slow but extensive bowel preparation pre-operatively; or
An invasive diagnostic procedure (e.g., aortogram, arteriogram or cardiac catheterization, myelogram) with major surgery scheduled for the following day; or
Close monitoring of blood sugars is required to provide adequate adjustment of regular insulin coverage in preparation for an operative procedure in a brittle insulin-dependent diabetic member (i.e., diabetic individuals who experience large, unpredictable changes in blood glucose, within short periods of time, as a result of very small deviations from schedule); or
Placement of fiducials (small screws) prior to stereotactic brain surgery; or
The member has a concurrent medical problem that requires specific inpatient treatment prior to major surgery (defined as craniotomy, laparotomy, median sternotomy, or thoracotomy) to reduce the operative risk or assure a more favorable outcome; or
The member is scheduled for an open heart procedure requiring cardiopulmonary bypass (cardiac valve replacement or repair, coronary artery bypass grafting) and has unstable angina, congestive heart failure, severe hypertension, or significant ventricular arrhythmias; or
The member requires intravenous steroid preparation for protection against a previously documented allergic reaction to dye prior to intravascular administration of dye necessary to perform a diagnostic study or operative procedure; or
The member requires intravenous steroid preparation, intravenous anti-convulsant protection, or osmotic diuresis prior to a craniotomy scheduled for the following day (e.g., intracranial arterio-venous malformations).
Hospitalization Prior to Transplant:
Members awaiting transplants are commonly hospitalized prior to surgery. Hospitalization of such individuals, however, is only considered medically necessary when the member has needs that justify inpatient confinement. Assessment of the medical necessity of hospitalization prior to transplant surgery is performed using the same criteria that are considered in assessing the medical necessity of hospitalization for other conditions.
CPT Codes / HCPCS Codes / ICD-9 Codes
Other CPT codes related to the CPB:
32096 - 32160
Thoracotomy, limited or major
33010 - 33980
Surgery, heart and pericardium
Laparotomy, with aspiration and /or injection of hepatic parasitic (e.g., amoebic or echinococcal) cyst(s) or abscess(es)
49000 - 49002
Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure) or reopening of recent laparotomy
61304 - 61576
Craniectomy or craniotomy
Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 simple cranial lesion
Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); each additional cranial lesion, simple (List separately in addition to code for primary procedure)
Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 complex cranial lesion
Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); each additional cranial lesion, complex (List separately in addition to code for primary procedure)
Application of stereotactic headframe for stereotactic radiosurgery (List separately in addition to code for primary procedure)
Craniotomy for repair of encephalocele, skull base
Myelography, posterior fossa, radiological supervision and interpretation
Myelography, cervical , radiological supervision and interpretation
Myelography, thoracic, radiological supervision and interpretation
Myelography, lumbosacral, radiological supervision and interpretation
Myelography, two or more regions (e.g., lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical), radiological supervision and interpretation
75600 - 75630
Other HCPCS codes related to the CPB:
Tissue marker, implantable, any type, each
Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment
Image-guided robotic linear accelerator-based sterotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment
Other ICD-9 codes related to the CPB:
250.00 - 250.93
276.0 - 276.9
Disorders of fluid, electrolyte, and acid-base balance
394.0 - 394.9
Diseases of mitral valve
396.0 - 396.9
Diseases of mitral and aortic valves
401.0 - 405.99
Intermediate coronary syndrome
Mitral valve disorders
427.0 - 427.9
Congestive heart failure, unspecified
560.0 - 560.9
Intestinal obstruction without mention of hernia
585.1 - 585.9
Chronic kidney disease
Muscular wasting and disuse atrophy, not elsewhere classified
Anomalies of cerebrovascular system
Personal history of allergy to radiographic dye
Long-term (current) use of anticoagulants
The above policy is based on the following references:
Bach DS. Management of specific medical conditions in the perioperative period. Prog Cardiovasc Dis. 1998;40(5):469-476.
Arom KV, Emery RW, Petersen RJ, et al. Patient characteristics, safety, and benefits of same-day admission for coronary artery bypass grafting. Ann Thorac Surg. 1996;61(4):1136-1139.
Schiff RL, Emanuelle MA. The surgical patient with diabetes mellitus: Guidelines for management. J Gen Intern Med. 1995;10:154-161.
Becker RC, Ansell J. Antithrombotic therapy: An abbreviated reference for clinicians. Arch Intern Med. 1995;155:149-161.
Kellerman PS. Perioperative care of the renal patient. Arch Intern Med. 1994;154:1674-1688.
American Society of Anesthesiologists (ASA). Basic Standards for Preanesthesia Care. Park Ridge, IL: ASA; October 14, 1987.
Kroenke K. Preoperative evaluation: The assessment and management of surgical risk. J Gen Intern Med. 1987;2:257-269.
Merli GJ, Weitz HH. Approaching the surgical patient. Role of the medical consultant. Clin Chest Med. 1993;14(2):205-210.
Cygan R, Waitzkin H. Stopping and restarting medications in the perioperative period. J Gen Intern Med. 1987;2:270-283.
Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.