UM Guidelines
Observation Goal Length of Stays

Inpatient and Surgical Care (ISC)

BCBST last reviewed June 15, 2016

Changed:

Reference
ID

Guideline

BCBST
GLOS

S-60

Achilles Tendon Repair

Observation

S-1045

Acromioplasty and Rotator Cuff Repair

Observation

S-22

Adrenalectomy by Laparoscopy

Observation

M-52

Angioplasty, Percutaneous Coronary Intervention

Observation

S-82

Ankle Dislocation, Closed or Open Reduction

Observation

S-100

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

Observation

S-152

Aortic Coarctation, Angioplasty

Observation

P-12

Apparent Life-Threatening Event

Observation

P-20

Appendectomy, Uncomplicated , Open or Laparoscopic, Pediatric

Observation

S-170

Appendectomy, without Peritonitis

Observation

S-175

Appendectomy, without Peritonitis, by Laparoscopy

Observation

S-200

Bladder Incision: Cystotomy

Observation

A-0167

Cardiac Pacemaker Implantation

Observation

S-282

Cardiac Septal Defect: Atrial, Transcatheter Closure

Observation

S-292

Cardiac Valvotomy, Percutaneous

Observation

A-0234

Carotid Artery Angioplasty with Stent Placement (CAS)

Observation

S-320

Cervical Fusion, Anterior

Observation

S-371

Cholecystectomy with Common Duct Exploration by Laparoscopy

Observation

A-0403

Deep Brain Stimulation (DBS)

Observation

S-580

EEG, Video Monitoring

Observation

P-580

EEG, Video Monitoring, Pediatric

Observation

S-420

Elbow Arthroplasty

Observation

S-424

Elbow Fracture, Open Treatment

Observation

M-157

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

Observation

S-430

Enucleation or Evisceration of Eyeball

Observation

S-445

Esophageal Diverticulectomy, Endoscopic

Observation

P-187

Failure to Thrive

Observation

S-460

Femur Fracture, Removal of Internal Fixation Device

Observation

S-490

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

Observation

S-505

Fundoplasty, Esophagogastric, by Laparoscopy

Observation

P-505

Fundoplasty, Esophagogastric, by Laparoscopy, Pediatric

Observation

S-515

Gastric Restrictive Procedure without Gastric Bypass by Laparoscopy

Observation

S-1305

Hernia Repair (Non-Hiatal)

Observation

S-632

Humerus Fracture, Closed or Open Reduction

Observation

S-665

Hysterectomy, Laparoscopic

Observation

S-660

Hysterectomy, Vaginal

Observation

S-710

Knee Arthrotomy

Observation

S-675

Knee Dislocation, Closed or Open Reduction

Observation

S-760

Orbital Exploration

Observation

S-770

Knee: Fracture of Tibial Plateau, Closed or Open Reduction

Observation

S-450

Laparotomy for Gynecologic Surgery, Including Myomectomy, Oophorectomy, and Salpingectomy

Observation

S-810

Lumbar Diskectomy, Foraminotomy, or Laminotomy

Observation

S-830

Lumbar Laminectomy

Observation

S-845

Lysis of Adhesions by Laparoscopy

Observation

A-0247

Mandibular Osteotomy

Observation

S-860

Mastectomy, Complete

Observation

S-862

Mastectomy, Complete, with Insertion of Breast Prosthesis or Tissue Expander

Observation

S-858

Mastectomy, Partial (Lumpectomy)

Observation

S-1000

Neck Dissection

Observation

P-300

Neutropenia after Chemotherapy, Pediatric

Observation

S-900

Orbital Exploration

Observation

S-910

Orchidectomy

Observation

S-930

Parathyroidectomy

Observation

S-950

Patent Ductus Arteriosus, Open, Thoracoscopic, or Transcatheter Closure

Observation

P-950

Patent Ductus Arteriosus, Open, Thoracoscopic, or Transcatheter Closure, Pediatric

Observation

S-1310

Percutaneous Revascularization, Lower Extremity

Observation

S-970

Prostatectomy, Transurethral Resection (TURP)

Observation

S-1020

Repair of Pelvic Organ Prolapse

Observation

S-1030

Retinal Detachment Repair

Observation

P-443

Slipped Upper Femoral Epiphysis, Closed Reduction

Observation

S-1072

Sympathectomy by Thoracoscopy or Laparoscopy

Observation

S-1082

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

Observation

S-1090

Thyroidectomy

Observation

S-1124

Tibia/Fibula Shaft Fracture, Closed or Open Reduction

Observation

S-1132

Tibial Osteotomy, Adult

Observation

S-1160

Urethral Diverticulum, Excision

Observation

S-850

Urethral Suspension Procedures

Observation

S-1172

Urethroplasty

Observation

A-0287

Uterine Artery Embolization

Observation

A-0226

Vertebroplasty and Kyphoplasty

Observation

S-1190

Vitrectomy

Observation

S-1210

Wrist Arthroplasty

Observation

References

BlueCross BlueShield of Tennessee network physicians. April - June 2016.

 


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