Code 44 determination

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"Example: Patient A was admitted at noon on Sunday. On Monday afternoon it was determined that the patient didn't meet inpatient criteria, the physician concurred, and the status was changed to outpatient. The outpatient status is considered to have begun at noon on Sunday. However, observation hours cannot be billed until the physician has written an order for observation. If the order was written at 2 p.m. on Monday, the hospital would begin the observation hours at that time. No observation can be charged between noon on Sunday and 2 p.m. on Monday."
 
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"Example: Patient A was admitted at noon on Sunday. On Monday afternoon it was determined that the patient didn't meet inpatient criteria, the physician concurred, and the status was changed to outpatient. The outpatient status is considered to have begun at noon on Sunday. However, observation hours cannot be billed until the physician has written an order for observation. If the order was written at 2 p.m. on Monday, the hospital would begin the observation hours at that time. No observation can be charged between noon on Sunday and 2 p.m. on Monday."

THank you for your response. My case here is in the order sheets,Patient was admitted to Inpatient on 8/31 and discharged on 9/1 @1227 hrs. After this, there was a note of change patient status from INpatient to Observation on 9/1 at 1243hrs and then a discharge note with the same time. As per CMS code 44 condition : The change in patient status from inpatient to outpatient is made prior to discharge or release, while the beneficiary is still a patient of the hospital; the problem here is the time of discharge is the same with the order of change status. WOuld you consider this as meeting code 44? And I would like to ask also who determines code 44, is it on medical coder's end or code 44 criteria was already decided and met before sending out the bill?

Thank you
 
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THank you for your response. My case here is in the order sheets,Patient was admitted to Inpatient on 8/31 and discharged on 9/1 @1227 hrs. After this, there was a note of change patient status from INpatient to Observation on 9/1 at 1243hrs and then a discharge note with the same time. As per CMS code 44 condition : The change in patient status from inpatient to outpatient is made prior to discharge or release, while the beneficiary is still a patient of the hospital; the problem here is the time of discharge is the same with the order of change status. WOuld you consider this as meeting code 44? And I would like to ask also who determines code 44, is it on medical coder's end or code 44 criteria was already decided and met before sending out the bill?

Thank you

This would be a good place to read about condition code 44 and all of the ins and outs: http://www.beckershospitalreview.co...1-things-to-know-about-condition-code-44.html

There are several items explaining what documentation is needed, which is likely the explanation as to why you're seeing so many notes. The notes made at 1243hrs are probably due to this and are not representative of the actual time of discharge to observation.

"9.Condition Code 44 changes a patient from inpatient to outpatient. If that patient continues to need hospital care, observation may be ordered at the time of the change and observation hour counting for billing purposes would begin at that time."

Based off this statement, it appears that you would use the time of the order on 9/1 (1227hrs), not the time the notes were entered (1243hrs).

There's also a CMS article here: https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/se0622.pdf
 
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