This patient has low medical complexities that require post-operative monitoring for complications but the procedure is not anticipated to cross 2 midnight.
The Medicare policy regarding the “two-midnight” rule is unchanged for TKA/THA patients. Providers must assure that documentation in the medical record supports medical necessity. When an inpatient is discharged before two midnights, the expected need for an inpatient stay (i.e., defined as a need for two-midnights) and unexpected early recovery resulting in the discharge must be thoroughly documented by the physician/treating provider, to be billed as an inpatient admission.
Factors which can be considered for 2 MN purpose in TKA/THA:
Inadequate pain control
Urinary retention / Ileus
Acute functional immobility
Physical therapy / Rehab needs
Social circumstances / Family support