Certified Inpatient Coding (CIC) Practice Exam

What key factor must be documented for the use of Condition Code 44 in an outpatient setting?

1. Physician's order alone

2. Utilization review committee's decision

3. Change of status documented in the medical record

4. Patient consent for outpatient status

The correct answer is: Change of status documented in the medical record

Condition Code 44 is utilized in outpatient settings to indicate a situation where a patient was treated as an outpatient when they may have required inpatient admission based on utilization review criteria. For this code to be correctly applied, it is essential that there is a clear document in the medical record denoting a change of status. This documentation must reflect why the decision was made to treat the patient in an outpatient capacity rather than admitting them as an inpatient. The change of status ensures that there is a clear understanding and justification for the care provided, adhering to policy guidelines and regulatory standards. By documenting this change, healthcare facilities can support their billing practices and avoid potential denials from payers, ensuring that their coding reflects the actual care delivered. The focus on documentation of a change of status underscores the necessity for comprehensive record-keeping in healthcare environments, where decisions are often closely scrutinized for compliance.