Condition code 44
Is anyone willing to share their process on documentation requirements for Condition Code 44? We are looking at options, not really happy with the current process. I am speaking in regards to the physician piece of the documentation guidelines.
Thanks Mandi
Mandi Robinson, RN, BS,CPC
Administrative Manager
Financial Services
CDI/Case Management
Trover Health System
270-326-4982
arobinso@trover.org
"Excellent Care, Every Time"
Thanks Mandi
Mandi Robinson, RN, BS,CPC
Administrative Manager
Financial Services
CDI/Case Management
Trover Health System
270-326-4982
arobinso@trover.org
"Excellent Care, Every Time"
Comments
I serve on our UR committee. We do not have a template that is followed for condition code 44. We have the attending document agreement in the record along with our physician advisor in the medical record. Most typically it is a dictated letter. The letter of course has to be dated and timed-as you know the condition code 44 must take place prior to the patient's discharge from the hospital and the patient must be informed.
Thanks,
Kathy
Kathy Shumpert, RN, CCDS
Clinical Documentation Improvement Specialist
Community Howard Regional Health
Office 765-864-8754
Cell phone 765-432-3961
Fax 765-453-8447
When something can be read without effort, great effort has gone into its writing. ~Enrique Jardiel Poncela
I will copy what we use from CM for Code 44's.
1. this is written after CM reviews chartwith Physician reviewers: "Reviewed patient's condition, treatment, and plan of care with Dr.(enter name), MD, Utilization Management committee physician. Per Dr. (enter name), there are no medical criteria for inpatient care. Outpatient observation services are appropriate.
2. order: Change patient from inpatient to outpatient observation services per my concurrence with the recommendation of the Utilization Management committee. sign MD (enter name/your name.
3. when attending concurs w/44: Spoke with Dr. ______________ and he/she agrees with the determination
of the Utilization Management committee that patient's level of care status is more appropriate for outpatient observation services. Order received to change patient's status from inpatient to outpatient observation services per Condition Code 44 policy.
4.when MD writes the order themselves(or physician responsible for the patient's care) writes the order to change the patient's status and the physician member of the UM committee (Dr.enter name) concurs; the following is to be documented in the patient’s pink progress notes:
Dr. _______ and Dr._______, UM committee physician, concur
patient has no medical criteria for inpatient care and that outpatient observation services are appropriate. Patient's status changed from inpatient to outpatient observation services per Condition Code 44 policy.
5. when MD refuses and you get 2 MDs from UR committee to agree for CC 44: Spoke with Dr. __________ from the UM committee. He/she agrees
with Dr.________'s (name of first UM committee physician) determination that there are no medical necessity criteria for inpatient care and patient's level of care status is more appropriate for outpatient observation services.
Hope this helps. It is part of our hospitals MCR guidelines and policy for Condition Code 44 from CMS requirements.
Sara Baine, MSN-Ed, CCDS
Chairperson CDMP Taskforce
SoutheastHEALTH
www.sbaine@sehealth.org
Mandi Robinson, RN, BS,CPC
Administrative Manager
Financial Services
CDI/Case Management
Trover Health System
270-326-4982
arobinso@trover.org
"Excellent Care, Every Time"
Thanks Mandi
Debby Dallen,RN CCDS
Clinical Documentation Coordinator
Albert Einstein Medical Center
Philadelphia PA 1941
We have organization created letter templates in Midas that Case Management completes patient name, reviewer, and reason for change fields. Letter is then printed out, copy given to patient and one placed on chart. There is a separate letter that goes to the physician that notifies them of Condition Code 44 change.
Dorie Douthit, RHIT,CCS