Q & A: Condition Codes W2 and 44

Q: Will a self-denial billed with condition code W2 have the same effect on the skilled nursing facility (SNF) three-midnight qualifying stay requirement as condition code 44?

A: Yes, in either case the patient will not qualify for a Medicare-covered skilled nursing stay. Medicare requires a three-night qualifying stay at a hospital in order for beneficiaries to qualify to payment of their SNF. Generally, the hospital stay has to be medically necessary, except in specific cases related to prior audit denials by contractors. When a hospital uses the condition code 44 process to turn the patient's stay back to an outpatient stay, the stay will not meet the requirements for a qualifying stay because it was not even considered an inpatient stay. In the case of a self-denial and inpatient Part B billing with condition code W2, the patient is still billed as in inpatient. However, because the stay is billed as non-covered, it also would not meet the requirements for a qualifying stay for skilled nursing benefits.

This Q&A was answered by Kimberly Anderwood Hoy Baker, JD, regulatory specialist for HCPro.  

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