Question

The local coverage determination provided discusses coverage for inpatient, observation and outpatient services. Based on the guidelines in the LCD which statement is true: I. Condition Code 44 can only be applied to a claim if the physician changes the patient status from inpatient to outpatient prior to discharge. II. The use of Condition Code 44 can be based solely on the physician's documentation of the order from inpatient to outpatient. III. Medicare will not pay for any Part B services furnished to an inpatient when payment cannot be made under Part A because the inpatient admission was determined to be not medically necessary.IV. Condition Code 44 is reported on the outpatient claim.

a. I, II, IV are correct
b. II AND III are correct
c. I and IV are correct
d. All choices are correct

Answer 1

The correct statements regarding the Local Coverage Determination (LCD) and the use of Condition Code 44 are I and IV (option c) , with the physician needing to change the patient status prior to discharge and reporting Condition Code 44 on the outpatient claim.

Step-by-step explanation:

The question relates to the Local Coverage Determination (LCD) and the use of Condition Code 44 in the context of Medicare billing for inpatient and outpatient services.


Upon reviewing the statements provided:

1. Condition Code 44 can only be applied to a claim if the physician changes the patient status from inpatient to outpatient prior to discharge.
   
   
2. The use of Condition Code 44 can be based solely on the physician's documentation of the order from inpatient to outpatient.
   
   
3. Medicare will not pay for any Part B services furnished to an inpatient when payment cannot be made under Part A because the inpatient admission was determined to be not medically necessary.
   
4. Condition Code 44 is reported on the outpatient claim.

The correct answer is c. I and IV are correct. Conditions I and IV are true according to guidelines, where the physician must change the status prior to discharge, and Condition Code 44 is reported on the outpatient claim. However, statement II is inaccurate as Condition Code 44 cannot be used solely based on the physician's documentation; it also requires a hospital committee review.



Statement III is incorrect because if inpatient admission is not medically necessary, Medicare may still cover Part B services under the Outpatient Prospective Payment System (OPPS), provided conditions are met for billing those services separately.