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Wiki inpt to obs

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jlb102780

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I do the billing for a group of doctors that see pts in the hospital. I've been noticing that the hosp will have a pt listed as inpt for 3 days or so and then change the pt to obs for the last day or two. Here's an example of one I found this morning:

pt came to the ED on 10/05/09, was admited as Inpt (the facesheet clearly states this), then the hosp changed the pt to obs on 10/08/09. So the pt is Inpt for DOS 10/05/09-10/07/09, moved to obs for DOS 10/08/09-10/09/09. I don't feel like this is right. Can they backtrack like this? I know you can start as obs and be admitted from there, but can you do it the other way around? Any help would be great before I call the hosp on this issue.
 
Yes they can do this but only after their UR evaluates the medical record and makes the decision that the patient more clearly meets the criteria for observation, however the catch here is there must be a physician order for the observation status and the UR is allowed to request this from the physician after discharge. But without the physician order then they may not. Check with your physician to see if he was requested to give an order for conversion to observation. In addition you need to look at the inpatient medical record to see if an order was written and by whom.
 
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