tci Medicare Compliance & Reimbursement - 2004 Issue 41

HOSPITALS: Once An Inpatient, Not Always An Inpatient

Know your patient's status with new condition code.Here's the deal: The physician admits a 71-year-old woman to an inpatient bed. But later the hospital utilization committee reviews the case and decides that the patient's care hasn't met the facility's requirements for inpatient admission. Should you bill the services as inpatient?No, according to a recent CMS transmittal - bill the services as outpatient. The agency has come up with a new condition code to describe this sticky situation: 44 (Inpatient admission changed to outpatient). You'll report this code on outpatient claims with bill types 13x or 85x.The...

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