Inpatient Facility Coding & Compliance Alert

Question: Please explain Condition Code 44 to me, and how we know it applies.
North Carolina Subscriber
Answer: Condition Code 44 is used when a decision is made to change a patient's status from inpatient to outpatient. Condition Code 44 requires that four components be met:

• The change of status is made prior to discharge and while the patient is still in the hospital.
• The hospital has not submitted an inpatient claim for the services.
• A physician agrees with the utilization review (UR) committee's decision, and that physician is either the attending physician or the second member of the UR committee.
• The physician's concurrence is documented in the patient's medical record.

If you determine that a case qualifies for Condition Code 44, the hospital should report the entire episode of care as an outpatient encounter, as though the inpatient admission never occurred. Review of admissions may be performed before, at, or after hospital admission.