Clearing up condition code 44 confusion
Case Management Monthly, November 1, 2009
This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Case Management Monthly.
CMS states that when a hospital uses condition code 44, “the entire episode of care” should be billed as outpatient. This vague language leads some case managers to believe that hospitals can retroactively change inpatient status to observation.
“I can see how a reader would come to that conclusion,” says Deborah K. Hale, CCS, president and CEO of Administrative Consultant Service, LLC, in Kickapoo, OK. “However, the linchpin is that the physician hadn’t ordered observation services.”
Hale says hospitals cannot use condition code 44 to retroactively bill for observation services because such billing can only be performed after the physician orders the services.
Language in the Medicare Claims Processing Manual, Chapter 4, §290.4.1, states that the HCPCS code for observation is used only after observation services are “ordered and provided.”
This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Case Management Monthly.
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