RE: Observation Beds and Policy

bosankorbosankor
edited May 2016 in CDI Talk Archive
I have a few questions I am hoping some of you will be willing to share what your organization is doing.


1.) Do you have observation beds and if yes are they scatter beds or in a physical designated location

2.) Do you have a separate charge for extended recovery post am-surg but does not warrant an IP stay for commercial payers?

3.) How do you handle ambulatory surgery patients who do not meet criteria for inpatient but are not considered safe to go home?

4.) How involved is your CDI program in observation cases or am surg converts?

Thank you all in advance for any feedback!

Roberta Bosanko-Cera MS, CDIP, CCS-P, CPMA, CPC-P, CEMC
AHIMA ICD-10-CM/PCS Training Instructor
Senior Director, ICD-10
Hospital For Special Surgery
535 E 70th Street
New York, NY 10021
bosankor@hss.edu
212-774-2906 Office

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Comments

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Hi Roberta,


    1. Yes, we have OBS beds, they are scattered. It is a 'status' and does not have any impact on where they are housed, treatment, staffing rations, etc

    2. I am not sure about this. I do not believe so.

    3. They stay in the facility under OBS status

    4. We are not. However, I think that depends a lot on whether you have a UR team that is carefully monitoring status. Our UR team monitors these patients, determines if they meet criteria for IP status, facilitates getting these orders from the MD's etc. I think some hospitals without a UR team that performs these duties may have CDI involved in this process.

    Hope that helps!

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • sharon.cooper@owensborohealth.orgsharon.cooper@owensborohealth.org
    edited May 2016
    Comments added to questions below.
    Sharon


    Sharon Cooper, RN-BC, CCS, CCDS, CDIP
    AHIMA-Approved ICD-10-CM/PCS Trainer/Ambassador
    Manager Clinical Documentation/Appeals/MDS/PPS

    Owensboro Health Regional Hospital
    P.O. Box 20007
    Owensboro, KY 42304-0007

    sharon.cooper@owensborohealth.org
    (270) 417-4612 Office
    (270) 316-9088 Cell
    (270) 417-4609 Fax
  • bosankorbosankor
    edited May 2016
    Thank you Katy!
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    In my response to #3 I said they stay in OBS but In reading Sharons response, I may have been confused. In our EMR, they say they are OBS (everyone is IP vs OBS) but as far as billing I do not know what happens. I do not believe they receive any additional charge unless something unexpected happened with the surgery.

    Sorry if that caused any confusion.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • tcrosslintcrosslin
    edited May 2016
    Does anyone know if a patient status can be changed from inpatient to observation on the day of admission before midnight? Where is this info found in CMS guidelines? I know it can be done with the use of condition code 44 but my facility has always allowed this change as long as the change was done before midnight on the day of admission.

    Theresa Crosslin RN-CM
    931-783-2078
  • debra.stewart@halifaxregional.comdebra.stewart@halifaxregional.com
    edited May 2016
    In our hospital with Out patient surgery if they need to be admitted to OBS or IP Case management gets involved and makes sure they meet criteria and if private insu they are preauth. For obs or ip, otherwise they just stay in out patient holding till stable to go home.


    Debra Stewart RN, BSN
    Clinical Documentation Specialist
    Sentara/Halifax Regional Hospital
    South boston, va. 24592
    (434)-517-3317 Work
    (434)-222-9884 Cell
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