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.
As patient advocates, case managers often need to question physician decisions that do not follow evidence-based criteria or that go against patient wishes.
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.
Methodist South Hospital in Memphis, TN, began using the Situation, Background, Assessment, and Recommendation (SBAR) tool to meet two basic needs: standardizing communication across the facility and managing complex cases.
Families often have to make difficult decisions when a loved one is in the ICU, and they rely on hospital case managers and social workers for support and information.
