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Your condition code 44 questions answered

Case Management Monthly, February 1, 2010

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Case Management Monthly.

Q: If we use condition code 44 to convert a patient to outpatient, are we at risk for not meeting the physician supervision requirement for certain services?

A: The new physician supervision requirement is that you must have a physician on the same campus for outpatient procedures. For larger institutions, you may have an ED that is close enough to fulfill this requirement.

However, smaller institutions might not have a physician, nurse practitioner, or physician advisor on campus 24/7. Although that’s okay when a patient is an inpatient, a physician, nurse practitioner, or physician advisor must be on campus to satisfy the outpatient requirement for direct supervision. Smaller hospitals need to be sensitive to the fact that if they convert and bill as outpatient services, they need to meet those direct supervision requirements.

Q: If we successfully change a patient to outpatient using condition code 44, but then the patient develops a condition that requires admission, can we revert the patient to inpatient?

A: Yes. Condition code 44 would still apply to the services provided before the inpatient admission to allow them to be billed as outpatient services if they are not included on the inpatient claim under the three-day rule.

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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