ICU Observation

SSummCCH

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Hello. We are a CAH and this is regarding hospital billing, not professional billing. I was asked about billing ICU Observation. I have been told by a couple of consultants that if a patient is ill enough for ICU, then need to be inpatient. The same would hold true for Isolation.
Is this true?
Thank you in advance.
 

thomas7331

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This is probably true in the majority of cases from a clinical perspective, but there is no blanket rule or regulation, that I'm aware of, that says that it must apply in all cases or that ICU service must be billed only as inpatient. Observation status is determined by the attending physician when there is insufficient information to make a decision as to whether or not the patient can be admitted to inpatient status or discharged, and additional testing or monitoring in the hospital is needed. The decision to place a patient in observation decision doesn't really have anything to do with whether those services will need to take place in ICU or in another part of the hospital.

Isolation is a different matter entirely, as that is made based on a patient's the potential risk of having an infection that could be passed to another patient. Patients may even placed in isolation as a precaution when an infection is suspected but not confirmed, and a patient that may need to be in isolation in a hospital could potentially be well enough to be discharged home. The need for isolation really has no bearing on whether the patient should be in observation or inpatient status.
 
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