Mobridge, SD
Best answers
I have a scenario that I have never come across before so I want to get some input.

Patient presents to ER on 1/6 for chest pain. Cardiac protocol followed. Patient was planned to be transferred out for higher level of care but no beds were available at any of the hospitals in the state. The patient was held as an extended ER until 1/9, when he was finally admitted as an Inpatient. He was then d/c on 1/10, less than 24 hours after the actual admit. During the time the patient was in Extended ER (not placed in Observation), they did receive services from our providers. However, they are not full notes so I will only have the ER E&M for 1/6. When patient was discharged, they were discharged home due to cardiac symptoms resolving with treatment at our facility. Patient will be closely following with cardiac provider (outside facility) but was not transferred to anyone else's care. Also during the time (1/6-1/9) the clinical director did not want the patient admitted to our facility (reasoning unknown) and that is documented. Also, when the patient was admitted on 1/9, the initial H&P sets the parameters for the patient to be discharged. No Discharge Summary was documented on 1/10.

What do I do with this?

My thoughts are do the ER E&M for 1/6, no pro fee for 1/7-1/8, but I am not sure what do to with the very short hospital stay for pro fees.
Facility charges, I think are limited to the ER facility charge, the IV administration of meds and related charges. Can I even do an inpatient overnight for 1/9-1/10? Because the patient was not placed in observation, I do not plan to code out the observation hours.

Any input would be greatly appreciated!
My thoughts are if MCR and less than 24 hour stay order should be reviewed(utilization review code 44) and amended and changed to OBS
this is what I am used to seeing when order is changed:
Order comments: Physician notified and in agreement with Utilization Review decision to change patient admission status to Outpatient with Observation Services.
Then there is a prog note from a physician that states: Code 44 reviewed and approved by the utilization review committee.

Different state but I believe with the MCR change in OBS rule this would still pertain and need to be OBS. If you complete as INPT it will probably be denied with the code 44 and
need to be reworked. Happy coding!