Case Management

Create a compliant condition code 44 process

Case Management Monthly, March 1, 2011

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Facilities that use condition code 44 often can take that as a sign that they have a poor inpatient screening process. Facilities that appropriately assign patient status from the beginning can avoid the condition code 44 hassle. 

Case managers can improve a facility’s patient status process if they apply inpatient criteria to patients who enter the hospital from all entry points, Bennett said. Case managers in the ED, bed placement department, and surgery can alert case managers on the floor to patients who don’t quite meet the criteria. The case managers on the floor can then review the chart again after the attending physician has assessed the patient and provided a more thorough assessment and plan of care.

For example, many direct admissions arrive to the hospital with symptom diagnoses (e.g., abdominal or chest pain), which means there is often not enough information to meet admission criteria. In those cases, the bed placement case manager should request that the case manager on the nursing unit review the case after the attending physician has rounded on the patient. The additional documentation may then support medical necessity for an inpatient admission. If inpatient criteria are still not met and there is an order for inpatient admission, it will then need a second-level physician review.

In order for the patient screening process to work correctly, case managers must properly apply the admission criteria, which shouldn’t be a difficult process, Bennett said. If case managers are exploring multiple ways and different subsets to try to get the case to meet criteria, they probably are not applying the criteria correctly, which makes those admissions questionable, she said.

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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