Health Information Management

Pay-Per-View: Inpatient to outpatient: Understand requirements of condition code 44

APCs Insider, March 26, 2010

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Mrs. Smith arrives in the ED at 8 a.m. Tuesday. Dr. Jones writes an admission order at 11:45 a.m. On Wednesday, the facility’s utilization review (UR) committee determines the admission was not medically necessary. Suddenly Mrs. Smith needs to be an outpatient and you have to figure out how to bill for the services she received. Thus enters condition code 44.
 
Condition code 44 changes a patient’s initial inpatient status to outpatient for purposes of billing and payment. It may be necessary to use condition code 44 when case management and other UR personnel are not available (e.g., weekends and holidays) at the time that a physician decides to admit a patient and the UR committee later determines that the patient does not meet Medicare’s inpatient criteria.
 
Continue reading “Inpatient to outpatient: Understand requirements of condition code 44” on the HCPro Web site. Briefings on APCs subscribers have free access to this article in the April issue.



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