About the Aerolib Orthopedic Risk Stratification Tool

Total knee arthroplasty is a reliable procedure in improving the quality of life in patients with end- stage degenerative joint disease. There is a significant increase in the volume of total knee arthroplasties due to growing elderly population and expansion of indications to younger population. With advances in operative procedure and post-operative management, there is decrease in the duration of hospital stay.

The Center for Medicare and Medicaid Services has removed Total Knee Arthroplasty (CPT Code 27447) from the Inpatient Only Procedure list from Jan 1, 2018. The means that the procedure can be billed as Part A Inpatient if the duration of stay crosses 2 midnights as part of medically necessary hospitalization.

The Centers for Medicare & Medicaid Services (CMS) published the 2020 Medicare Hospital Outpatient Prospective Payment (OPPS) and Ambulatory Surgical Center Payment Systems Final Rule on November 12, 2019. In the Rule CMS removed total hip arthroplasty (THA) CPT code 27130 from the CMS inpatient only list (IPO) and added total knee arthroplasty (TKA) to the Ambulatory Surgical Centers (ASC) Covered Surgical Procedures List (CPL) in CY 2020.

This Orthopedic Surgery Risk tool can be used to aid in pre-operative optimization and assist the Physician Advisor to assess for medical necessity and appropriate bedding status.

The Orthopedic Surgery Risk Tool uses an algorithm to predict postoperative complications, reoperations and readmissions in patients undergoing Total Knee Arthroplasty and Total Hip Arthroplasty. Several patient specific factors have been associated with post-operative complications after Total Knee Arthroplasty, and stratifying and adjusting modifiable risk factors pre-operatively has been proposed to mitigate adverse events. Bivariate analyses using simple logistic regression and chi-square test were used to determine relationship between secondary outcomes and analytics score. Multivariate logistic regression with backward elimination was used to assess predictors while controlling for some variables.


This tool has been developed after a retrospective review of data and focuses on determining patients at risk for adverse events but cannot determine causality. The tool cannot tell the difference between surgical techniques, hospitals with variable volumes of procedures and surgeon data for operative outcomes. The tool does not take into account socioeconomic status of patient which can correlate with post-operative adverse events. The tool does not account for patient reported outcomes.

Aerolib LMS: On-demand E-learning system for Clinical and Regulatory education for Physicians, Physician Advisors, Case managers, Utilization Review personnel and Hospital Administration that is based on Aerolib`s successful education methodology of Disease Specific Documentation Improvement.

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