General Question for the Week of February 13, 2017

General Compliance Question of the Week

Question:

What are the billing guidelines for assigning condition code 44?

Answer:

Condition code 44 is assigned when a patient who was originally admitted as an inpatient is changed to an outpatient because, after review, the patient does not meet the hospital’s inpatient admission criteria.

For Medicare patients, there is a set of criteria that must be met in order for condition code 44 to be assigned. The following must be documented:

  • The change in the patient’s status from inpatient to outpatient must be made prior to dis-charge or release while the patient is still physically located in the hospital.
  • The facility has not submitted a claim for Medicare for the inpatient stay.
  • A physician has reviewed the recommendation from the utilization review committee and concurs with the decision change.
  • The physician’s concurrence is documented in the medical record.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.