Health Information Management

Tip: Know criteria for using condition code 44

APCs Insider, April 2, 2010

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Condition code 44 changes a patient’s initial inpatient status to outpatient for purposes of billing and payment.

Report condition code 44 on the outpatient bill (013X) that you submit to recover reimbursement for services provided in the inpatient setting. Medicare covers and reimburses those inpatient services on the same terms and conditions as if they had been provided in the outpatient setting, provided you meet all of the following criteria:
  • Utilization review (UR) committee determines that the patient does not meet inpatient criteria
  • UR committee changes the status before the patient is discharged and the claim submitted
  • Attending physician concurs with the change in status and documents concurrence in the medical record
 
This tip is adapted from “Inpatient to outpatient: Understand requirements of condition code 44” in the April issue of Briefings on APCs



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