Tip: Know criteria for using condition code 44
APCs Weekly Monitor, 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.
- 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
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