Wiki UR Problem on Hospital Admission

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lcathey@smsc.org

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Help Please! This is the first time this has happened and we can't find any guidelines on this. One of our physicians did an inpatient admission on a Saturday and discharge on Sunday. When Utilization Review came in on Monday they said it didn't qualify for inpatient status and the hospital is billing Medicare Part B, but they cannot change the status to observation because the patient was already discharged. How do we code for the physician? :(
 
What did you end up doing with this?? I would have done a 99223 as your physician did a full exam and at the time wrote for an inpatient admission. Just because the hospital checked some boxes on interqual criteria module and deemed it not medically necessary doesn't mean he didn't think the patient would recover so quickly and warranted an inpatient admission.
 
Medicare has a rule that the hospital can request that a patient status be converted to observation after they have been discharged, You provider just writes an amended note and you submit a corrected claim for observation codes instead of inpatient.
 
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