CMS announces new transmittal on changing status from inpatient to outpatient
Compliance Monitor, September 22, 2004
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A new condition code will be implemented on October 12 to help ease the administrative problems when you have to change an inpatient admission to outpatient.
The change, published September 10, will be retroactive to claims filed as of April 2004.
Condition Code 44 can be used only on outpatient claims in an instance when the physician ordered inpatient services, but upon internal review performed before the claim was initially submitted, the hospital determined the services did not meet its inpatient criteria, according to CMS.
In order for the hospital to change a beneficiary's status from inpatient to outpatient, you must submit an outpatient claim (TOBs 13x, 85x) for medically necessary Medicare Part B services furnished to the beneficiary. However, the following conditions must be met:
For more information, click here.
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