Q&A: Should MOON be delivered due to status change?

Q: Do we give a MOON letter to a patient who was originally assigned to inpatient status, but then reassigned to observation services when the utilization review committee determined that he or she did not meet inpatient criteria. In this instance, condition code 44 was used and the patient’s status was changed to observation. If we are required to deliver the MOON form in this situation, should it be given to the patient at the same time as the patient is given information on condition code 44?

A: If the condition code 44 process is used to convert an inpatient to outpatient with observation, the clock starts ticking at the time the change is made. The MOON is required if the patient surpasses 24 hours of observation. That said, CMS doesn’t prohibit providing the MOON at the time of the status change. It should also be noted that the condition code 44 process requires notifying the patient in writing of the fact that his or her inpatient admission was found to be medically unnecessary.

If the MOON is given to the patient at the time of the condition code 44 change, it can also meet the requirement for the condition code 44 notification but only if the notation about the inpatient admission being found medically unnecessary is added to the “additional information” section of the MOON form.

Editor’s note: This question was answered by Ronald Hirsch, MD, FACP, CHCQM, of R1 Physician Advisory Services in Chicago.

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