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Condition Code 44--Inpatient admission changed to outpatient – For use on outpatient claims only, when the physician ordered inpatient services, but upon internal review performed before the claim was initially submitted, the hospital determined the services did not meet its inpatient criteria.
The Use of Condition Code 44. • In some instances, a physician may order a beneficiary to be admitted to an inpatient bed, but upon subsequent review, it is determined that an inpatient level of care does not meet the hospital’s admission criteria.
Medicare Condition Code 44 is used when an inpatient admission needs to be changed to outpatient status. There are some instances where a Medicare patient was admitted to the hospital with an inpatient status, but upon review it is deemed more appropriate for the entire encounter to be an outpatient encounter.
Using the NUBC Condition Code 44 involves adding the code to a claim of a patient who was changed from inpatient to outpatient before the inpatient claim was submitted, because the hospital determined the services did not meet inpatient criteria.
Condition Code 44. When a physician orders an inpatient admission, but the hospital's utilization review committee determines that the level of care does not meet admission criteria, the hospital may change the status to outpatient only when certain criteria are met.
So, what does one do when a patient is admitted as an inpatient and is found after review to not certified as such? This is where Condition Code 44 comes into play. The National Uniform Billing Committee (NUBC) issued Condition Code 44, effective April 1, 2004, to identify cases when this occurs.
When the Condition Code 44 process is used, the entirety of the hospital stay becomes an outpatient encounter. This necessitates the use of outpatient hospital as the place of service for all...
But getting a Medicare inpatient into the correct status creates an administrative wrinkle: the dreaded billing Code 44. Consider this scenario: utilization review produces an order changing a patient from inpatient to observation status and a chart note while the patient is still in-house.
Thankfully, Condition Code 44s exist to allow hospitals to adjust patient status and inform the patient prior to discharge. CMS clearly articulates that Condition Code 44s should be a rare occurrence to correct patient status. They should be evaluated, with each event being internally audited to determine opportunities for prevention.
Condition Code 44 is a billing code used when a hospital determines that a traditional Medicare patient who is currently admitted as an inpatient does not meet medical necessity for inpatient care.