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Observation vs. Inpatient

  1. #1
    Question Observation vs. Inpatient
    Medical Coding Books
    Good morning all!

    I work for a general surgery practice and recently, because of the lovely RAC's, we have been having issues with one of our hospitals and the Inpatient Vs. Observation status. My coworker (also a CPC) and I have always billed for a patient that is in the hospital more than 24 hours as Inpatient (regardless of how the surgery was originally planned)... Recently, because the RAC's are denying the hospital's Inpatient claims as "not medically necessary", if the surgery was originally planned to be observation, the hospital will bill as such. When their claim gets denied, they instruct the patient to call us and have us "change our coding". Has anyone else been having this issue? If so, what can be done to remedy the situation?

    Erin Toavs, CPC

  2. #2
    Default Inpatient Vs Outpatient
    I too work for general surgery. I log onto the hospital system and look at the patient status IH vs OH and code based on that. When we board the surgery, we tell the scheduler that the procedure is scheduled for OH or IH (and they enter specific codes into the hospital system based on that) BUT we have been told that the status can not be determined until after the surgery has been performed and the physician makes that determination at that time. Also, a patient can remain in outpatient status for longer than 24 hours, so it's not always 24 hours.

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