Health Information Management

Q&A: Required inpatient length of stay

HIM-HIPAA Insider, May 25, 2010

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Q: I’ve always heard that inpatient status requires a specific time frame. For example, must a patient remain in the hospital for at least 24 hours to be considered an inpatient?

A: No. Medicare has said that although it generally expects inpatients to remain overnight, a 24-hour time frame is not a prerequisite to a medically necessary inpatient admission.
 
This is evidenced by the multitude of one-day stays that Medicare has deemed appropriate.
The decision to admit a patient is complex and requires medical judgment that considers the following factors, none of which reference a time frame: 
  • Patient’s medical history and current needs
  • Types of inpatient and outpatient facilities available
  • Hospital’s bylaws and admission policies
  • Appropriateness of treatment in each setting
  • Severity of signs and symptoms
  • Medical probability of an adverse outcome
Refer to the Medicare Benefit Policy Manual, Chapter 1, Section 10 for more information. Note that CMS has said planned procedures, which include a known diagnosis and intended stay of fewer than 24 hours, should be treated on an outpatient basis.
 
Editor’s note: Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance at HCPro, Inc., in Marblehead, MA, answered this question in the May 2010 issue of Briefings on Coding Compliance Strategies.

 



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