CMW tip of the week: Billing for injections and infusions using condition code 44
Case Management Weekly, September 2, 2009
Want to receive articles like this one in your inbox? Subscribe to Case Management Weekly!
This week’s tip, an “Ask the Expert,” was answered by Judith Kares, JD, CPC, a regulatory specialist for HCPro, Inc.
Q. My understanding of the condition code 44 process is that we technically don’t have an order for observation until the actual observation order written. Does this mean that we may not charge for all the infusions and injections administered while the patient’s status was incorrectly inpatient?
A. No. My understanding is as follows. When you are able to successfully change the patient's status from inpatient to outpatient, using condition code 44, services provided in the inpatient setting are covered and payable on the same terms and conditions as if they had been provided in the outpatient setting. Because the hospital did not meet the observation order requirement, however, it may not convert that period of inpatient care to observation. Therefore, there should be no separate line item reported on the subsequent outpatient claim for observation services. All of the ancillary services, however, would generally be billable, subject to outpatient coverage and payment provisions.
A. No. My understanding is as follows. When you are able to successfully change the patient's status from inpatient to outpatient, using condition code 44, services provided in the inpatient setting are covered and payable on the same terms and conditions as if they had been provided in the outpatient setting. Because the hospital did not meet the observation order requirement, however, it may not convert that period of inpatient care to observation. Therefore, there should be no separate line item reported on the subsequent outpatient claim for observation services. All of the ancillary services, however, would generally be billable, subject to outpatient coverage and payment provisions.
Have a tip or tool you’d like to share? Or maybe a question for our experts? E-mail it to Associate Editor Ben Amirault at bamirault@hcpro.com.Your comments or ideas might appear in a future issue of Case Management Weekly.
Want to receive articles like this one in your inbox? Subscribe to Case Management Weekly!
Related Products
-
Case Management Weekly
Case Management Weekly is a free e-mail newsletter that offers news, resources, and Q&As to help case managers from all...
-
Case Management Monthly
This newsletter offers case studies, best practices, and how-to analysis to help case managers move patients through the...
Most Popular
- Articles
-
- HIPAA Q&A: Flu shot requirement for hospital employees
- Running an effective peer review committee meeting
- HealthDataInsights posts new issues for medical necessity claims
- Sneak Peek: Effort underway to establish caseload benchmarks
- Q/A: Coding for telescopic intraocular lens
- New FAQ posted on storing laryngoscope blades
- Tip: Perform your own internal investigation prior to government audit
- HIPAA 5010 deadline extended, but threat remains, says AMA
- HHS task force: Consider privacy, security with text messages
- What does case-mix index mean to you?
- E-mailed
-
- Running an effective peer review committee meeting
- HIPAA Q&A: Flu shot requirement for hospital employees
- HHS task force: Consider privacy, security with text messages
- What does case-mix index mean to you?
- Q/A: Coding for telescopic intraocular lens
- Q/A: Correct use of modifier -PT
- Tip: Correctly code bilateral pain management procedures
- "Wall fountains" may be spreading Legionnaires to patients, visitors
- 2012 CPT code changes for ASCs: Shoulder and knee scopes and pain management
- Case Management Monthly, March 2012
- Searched