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out pt stays

Cheryll Posted Wed 10th of June, 2015 15:09:27 PM

My question is if a pt has an outpt surgery and then stays overnight, example: Day Surgery 5.27.15, but then does not go home until the next day; Hospital Dictation shows Day Surgery 5.27.15 - 5.28.15 Would the next day 5.28.15 be considered an inpt or out pt. Need to know for Medicare and also commercial payers. Thank you!

SuperCoder Answered Thu 11th of June, 2015 06:33:23 AM

Well, for medicare an inpatient admission is generally appropriate when you are expected to need 2 or more midnights of medically necessary hospital care, but your doctor must order such admission and the hospital must formally admit you in order for you to become an inpatient. And for commercial payers you have to check with your payer, but it is most likely the same rule might be applicable for the commercial payer as well. So, in your case it will count as out-patient only.

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