Ambulatory or 1 & 1-day Goal Length of Stay


	UM Guidelines

Inpatient and Surgical Care (ISC)

BCBST modification effective June 28, 2007*

Changed:

The following Goal Length of Stays have been modified to 23 hour observation.

ORG

Guideline

BCBST Modified GLOS

S-22

Adrenalectomy, Unilateral, by Laparoscopy

23-hr

S-82

Ankle Dislocation, Open or Open Reduction

23-hr

S-90

Ankle Fracture, Closed, Open Reduction, Internal Fixation (ORIF)

23-hr

S-100

Ankle Fracture, Complex, Open Reduction, Internal Fixation (ORIF)

23-hr

S-152
Aortic Coarctation, Angioplasty
23-hr

P-20

Appendectomy, Uncomplicated, Open or Laparoscopic

23-hr

S-170

Appendectomy, without Peritonitis

23-hr

S-175

Appendectomy, without Peritonitis, by Laparoscopy

23-hr

S-200

Bladder Incision: Cystotomy

23-hr

S-282
Cardiac Septal Defect: Atrial, Transcatheter Closure
23-hr

S-292

Cardiac Valvotomy, Mitral, Percutaneous

23-hr

S-320

Cervical Fusion, Anterior

23-hr

S-371

Cholecystectomy with Common Duct Exploration by Laparoscopy

23-hr

S-424

Elbow: Fracture of Olecranon, Open Treatment

23-hr

S-422

Elbow: Unicondylar Fracture, Open Treatment

23-hr

S-420
Elbow Arthroplasty
23-hr

M-157

Electrophysiologic Study and Implantable Cardioverter-Defibrillator (ICD) Insertion, Transvenous

23-hr

S-445

Esophageal Diverticulectomy, Endoscopic Stapling

23-hr

S-490

Foot Fracture, Calcaneus or Talus, Open Reduction, Internal Fixation (ORIF)

23-hr

S-515
Gastric Restrictive Procedure without Gastric Bypass by Laparoscopy
23-hr

P-204

Hemopohilia

23-hr

S-632

Humerus Fracture, Open or Open Reduction

23-hr

P-207
Idiopathic Thrombocytopenic Purpura (ITP)
23-hr

S-710

Knee Arthrotomy

23-hr

S-810

Lumbar Diskectomy, Foraminotomy, Laminotomy, Multiple Levels

23-hr

S-830

Lumbar Laminectomy

23-hr

S-1012

Radius/Ulna Fracture, Open or Open Reduction

23-hr

S-530

Removal of Posterior Spinal Instrumentation

23-hr

S-1020

Repair of Cystocele, Rectocele, or Enterocele

23-hr

P-443

Slipped Upper Femoral Epiphysis, Closed Reduction

23-hr

S-1062

Splenectomy by Laparoscopy

23-hr

M-81

Stroke: Cerebral Thrombosis, Patient Independent in Ambulation

23-hr

S-1072

Sympathectomy by Thoracoscopy or Laparoscopy

23-hr

S-1082

Thoracotomy with Biopsy or Miscellaneous Procedure by Video-Assisted Thoracic Surgery (VATS)

23-hr

S-1111

Tibia/Fibula Shaft Fracture Closed, Closed Reduction without Internal Fixation

23-hr

S-1131

Tibial Osteotomy for Genu Varus or Valgus, Child or Adolescent

23-hr

S-1132

Tibial Osteotomy, Adult

23-hr

S-850

Urethral Suspension Procedures

23-hr

* These guideline(s) have been revised from the Milliman USA Milliman Care Guidelines. The portions of the guideline(s) which have been revised are identified through the use of [insert: italic, boldface, underlined, etc. as appropriate] text, and Milliman USA has neither reviewed nor approved the modified material. Any statement to the contrary or association of the modified material with Milliman USA is strictly prohibited. This document has been classified as public information.

The above information only contains the modified portion of the Milliman Care Guideline. If you wish to view the complete Milliman Care Guideline, please contact Milliman USA.

	Changed:


	The following Goal Length of Stays have been modified to 23 hour observation.

ORG	Guideline	BCBST Modified GLOS
S-22	Adrenalectomy, Unilateral, by Laparoscopy	23-hr
S-82	Ankle Dislocation, Open or Open Reduction	23-hr
S-90	Ankle Fracture, Closed, Open Reduction, Internal Fixation (ORIF)	23-hr
S-100	Ankle Fracture, Complex, Open Reduction, Internal Fixation (ORIF)	23-hr
S-152	Aortic Coarctation, Angioplasty	23-hr
P-20	Appendectomy, Uncomplicated, Open or Laparoscopic	23-hr
S-170	Appendectomy, without Peritonitis	23-hr
S-175	Appendectomy, without Peritonitis, by Laparoscopy	23-hr
S-200	Bladder Incision: Cystotomy	23-hr
S-282	Cardiac Septal Defect: Atrial, Transcatheter Closure	23-hr
S-292	Cardiac Valvotomy, Mitral, Percutaneous	23-hr
S-320	Cervical Fusion, Anterior	23-hr
S-371	Cholecystectomy with Common Duct Exploration by Laparoscopy	23-hr
S-424	Elbow: Fracture of Olecranon, Open Treatment	23-hr
S-422	Elbow: Unicondylar Fracture, Open Treatment	23-hr
S-420	Elbow Arthroplasty	23-hr
M-157	Electrophysiologic Study and Implantable Cardioverter-Defibrillator (ICD) Insertion, Transvenous	23-hr
S-445	Esophageal Diverticulectomy, Endoscopic Stapling	23-hr
S-490	Foot Fracture, Calcaneus or Talus, Open Reduction, Internal Fixation (ORIF)	23-hr
S-515	Gastric Restrictive Procedure without Gastric Bypass by Laparoscopy	23-hr
P-204	Hemopohilia	23-hr
S-632	Humerus Fracture, Open or Open Reduction	23-hr
P-207	Idiopathic Thrombocytopenic Purpura (ITP)	23-hr
S-710	Knee Arthrotomy	23-hr
S-810	Lumbar Diskectomy, Foraminotomy, Laminotomy, Multiple Levels	23-hr
S-830	Lumbar Laminectomy	23-hr
S-1012	Radius/Ulna Fracture, Open or Open Reduction	23-hr
S-530	Removal of Posterior Spinal Instrumentation	23-hr
S-1020	Repair of Cystocele, Rectocele, or Enterocele	23-hr
P-443	Slipped Upper Femoral Epiphysis, Closed Reduction	23-hr
S-1062	Splenectomy by Laparoscopy	23-hr
M-81	Stroke: Cerebral Thrombosis, Patient Independent in Ambulation	23-hr
S-1072	Sympathectomy by Thoracoscopy or Laparoscopy	23-hr
S-1082	Thoracotomy with Biopsy or Miscellaneous Procedure by Video-Assisted Thoracic Surgery (VATS)	23-hr
S-1111	Tibia/Fibula Shaft Fracture Closed, Closed Reduction without Internal Fixation	23-hr
S-1131	Tibial Osteotomy for Genu Varus or Valgus, Child or Adolescent	23-hr
S-1132	Tibial Osteotomy, Adult	23-hr
S-850	Urethral Suspension Procedures	23-hr