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code 44 guidelines

Diana. Posted Wed 11th of January, 2012 16:24:11 PM

Do both physician signatures on the code 44 utilization sheet have to be on the sheet before the patient is discharged or is it okay for one signature to be on the sheet and the other physician sign after the patient is discharged?

SuperCoder Answered Wed 11th of January, 2012 17:28:57 PM

Those inpatient services are covered and reimbursed on the same terms and conditions as if they actually had been provided in the outpatient setting, so long as all of the following criteria are met:

-The decision to change status must be made by the hospital’s “utilization review committee” (UR committee). One “member” of the UR committee can make the decision, with the attending physician’s agreement; in all other cases, the decision must be made by at least two “members.” The change in status must be made prior to discharge or release of the patient and before the hospital has submitted a claim for the inpatient admission;

-A physician must concur with the decision;

-The physician’s concurrence must be documented in the patient’s medical record; and

-The UR committee must provide written notice to the hospital, the patient and the patient’s physician within two days (but not later than the patient’s discharge or release from the hospital) of the change and its impact on the patient, including financial liability for applicable deductible and coinsurance amounts.
The first and last criteria above answered your query.

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