title: Condition Code 44 or Condition Code W2?
abstract: When hospitals determine after discharge that a patient did not meet inpatient criteria, they can file a provider liable claim using Condition Code W2 and be reimbursed for all services as if the patient were an outpatient, according to Deborah Hale, CCS, CCDS. The claims must be filed within 12 months after discharge. The medical record must be reviewed by the physician advisor and the utilization review committee before the claim is submitted. It is still advantageous to get the patient status right up front.
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S. / Q000191:economics* / Q000592:standards; D004282:Documentation / Q000592:standards; D006801:Humans; D007344:Insurance Claim Reporting; D008485:Medical Audit / Q000191:economics; D010343:Patient Admission / Q000191:economics* / Q000592:standards; D010351:Patient Discharge / Q000191:economics* / Q000592:standards; D011445:Prospective Payment System / Q000592:standards / Q000639:trends; D014481:United States; D014600:Utilization Review / Q000191:economics / Q000592:standards