Health Information Management

Tip: Criteria for condition code 44

APCs Insider, June 19, 2009

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Condition code 44, “inpatient admission changed to outpatient,” allows hospitals to change a patient’s status from inpatient to observation. This change can occur only  when a patient scenario meets the following four criteria:
  • The patient is still in the hospital
  • The facility has not  submitted the patient’s claim to Medicare
  • A physician (preferably the attending physician) agrees with the utilization review (UR) committee’s decision that outpatient care is more appropriate for the patient
  • A physician (preferably the attending physician) documents in the patient’s medical record his or her concurrence with the UR committee’s recommendation for a change in status
This tip was adapted from the article “The quick list: Condition code 44” in the June issue of Briefings on Coding Compliance Strategies.

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