February 18, 2021
By Juliet B. Ugarte Hopkins, MD, CHCQM-PHYADV Deconstructing the Concept of Condition Code 44
Condition Code 44 is a code added to a claim. As it turns out, we have all been overthinking the concept of Condition Code 44. Ready for a bit of a history lesson, followed by having your mind blown? Here we go. On April 1, 2004, in response to a…
By Marvin D Mitchell, RN, BSN, MBA
This decision applies only to those whose stay was changed to observation after inpatient admission. In a decision released on March 24, a judge of the U.S. District Court for the District of Connecticut released a memorandum of decision in the case of Alexander v. Azar, creating new appeal rights…
By Alvin Gore, MD, CHCQM and Cathi Charlberg, LVN, CHCQM
A complex process is simplified in a tabular comparison. Not infrequently, in the process of utilization review (UR), we run into situations in which, as physician advisors, we get to review Medicare cases that do not match their original “label” (i.e. the initial status selection was likely not a proper…
By Juliet B. Ugarte Hopkins, MD, CHCQM-PHYADV
The topic of Condition Code 44 is not new. Detailed by the Centers for Medicare & Medicaid Services (CMS) in September 2004 via MLN Matters SE 0622, titled Clarification of Medicare Payment Policy When Inpatient Admission is Determined not to be Medically Necessary, Including the Use of Condition Code 44:…
March 29, 2017
By Ronald Hirsch, MD Using Condition Code 44 Correctly for Pre-Admissions
Gabby Nunez from Community Memorial Health System in Ventura, Calif. recently asked the RAC Relief user group about the patient who insists on being admitted as an inpatient solely to try to get the three days to qualify for a Part A nursing home payment.This is not an infrequent problem…