Cms manual condition code 44

Fiscal intermediaries use Condition Code 44 for tracking purposes only so the reimbursement that the hospital receives will be the same as it would receive for other outpatient services. Specifically, hospitals under OPPS will receive reimbursement based on APCs while critical access hospitals will receive reimbursement based on cost.  · Condition code 44; Include charges for services that were furnished per a physician order; Observation: Only services provided per a physician order can be billed on the outpatient claim. Therefore, providers may not begin counting observation hours until such time as an order for observation is given. Example: Patient A was admitted at noon on Sunday.  · Condition code 44 is used when an inpatient admission is being changed to outpatient. According to the CMS IOM Pub. , Medicare Claims Processing Manual, Chapter 1 -- General Billing Requirements, condition code 44 is.

ANSWER: The use of Condition Code 44 pertains to the entire patient encounter, the patient’s status, and the hospital bill type submitted. Medicare does not recognize a separate patient status called “observation;” all hospital patients are either inpatients (if they are admitted as inpatients on the order of a physician) or outpatients (registered by the hospital as outpatients). Condition code 44 was instituted by CMS in to allow hospitals, through their utilization review process with the involvement of a physician member of the utilization review committee, to change a patient’s status from inpatient to outpatient. - Policy and Billing Instructions for Condition Code 44 60 – Provider Billing of Non-covered Charges on Institutional Claims - General Information on Non-covered Charges on Institutional Claims - Basic Payment Liability Conditions - Billing Services Excluded by Statute - Claims with Condition Code

١٥‏/٠٩‏/٢٠١٦ Hospitals use condition code 44 and condition code W2 to bill for Medicare Part B payment in cases where the attending physician orders an. ٠١‏/٠٤‏/٢٠٢٠ Your doctors can change a Medicare inpatient to outpatient with an order and not use the Condition Code 44 process. CMS has not waived CMS IOM , Medicare Benefit Policy Manual, Chapter 1, Condition code 44 does not affect amount of outpatient payment that would otherwise be made.