Comments on: Observation with condition code 44 and physician supervision

By: DEBBIE MILLER

DEBBIE MILLER — Thu, 23 Jul 2009 20:26:24 +0000

I was reading in material from HCPRO about when the person is changed from an inpatient to an outpt after review of MD and UR that the inpt order will be as if it was never written if this is the case could we not bill starting when the pt had the first nursing care started?Thank you for your help.

By: Andrea Kraynak, CPC-A

Andrea Kraynak, CPC-A — Wed, 08 Apr 2009 14:39:11 +0000

Many readers have responded with questions on condition code 44, and our regulatory specialists Kimberly Hoy and Judith Kares felt it would be helpful to write more on the subject. To view the second installment on this topic, please view the April 8 posting “Condition Code 44 – Let’s focus on process,” visit http://blogs.hcpro.com/revenuecycleinstitute/2009/04/note-condition-code-44-lets-focus-on-process/. Further information from Hoy and Kares will be coming early next week.

By: Janan McElroy Director of Case Management

Janan McElroy Director of Case Management — Tue, 07 Apr 2009 16:48:40 +0000

I also was under the impression that code 44 was put into place to avoid inappropriate admission and placing the patient into the right status. I thought once that code 44 was ordered it was effective from the start of care, which is reflected upon the patient being bedded with a nursing assessmnet inplace. This process initates per CMS Quality Insights 8sow-de-gen-06-12

By: Director of Quality and Case Management

Director of Quality and Case Management — Tue, 07 Apr 2009 16:05:53 +0000

The scenario described does not make sense, it penalizes those that are trying to do the right thing and avaoiding an inappropriate admission. If you can only bill for observation from the time that the order is written, you can not bill for this visit at all. My understanding is that the rule regarding from the time that the order is written applies to changes from observation to inpatient not the other way around, after which you get paid for the entire stay as an admission regardless of number of hours.

By: Director of Case Management

Director of Case Management — Tue, 07 Apr 2009 15:45:07 +0000

I thought the idea behind Condition Code 44 was that the patient status should have been observation from the outset. Isn’t it a way of “erasing” an erroneous inpatient admit? In the example provided, the patient was Admitted at 9:00, whether it was to inpatient or observation is secondary. If Observation begins at 4pm, what would be billed from 9am – 4pm? The patient is not still an ER patient.