Ask the expert: Application of condition code 44
HIM Connection, September 23, 2008
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Q: It is my understanding that we should apply condition code 44 when the physician does not agree with a patient’s status change. At our facility, if the physician challenges the change in patient status, the next step is to go to the utilization review (UR) committee. At that point, we are supposed to apply condition code 44. Would you please clarify?
A: You must meet four requirements to use condition code 44. One of these conditions is that the attending physician must agree with the status change. Do not use condition code 44 if the attending physician disagrees. According to CMS, the UR committee must make the decision that the inpatient status is incorrect. This must happen before approaching the attending physician to ask him or her to make the status change.
Editor’s note: TMF Health Quality Institute in Austin, TX, answered this question. It appeared in the September issue of Briefings on Coding Compliance Strategies. For more information, visit www.hcpro.com/content/217372.cfm.
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