Observation services are a specific set of services provided to a patient while the physician decides whether to admit or discharge the patient. That means if a patient undergoes a procedure that requires “active monitoring,” he or she is not receiving observation services during the procedure.
As patient advocates, case managers often need to question physician decisions that do not follow evidence-based criteria or that go against patient wishes.
CMS’ rules for properly applying condition code 44 are hard enough to understand, but when it comes to putting those rules into practice, things can get even more difficult.
