Q: A patient with undiagnosed syncope is admitted to observation. Later that evening, the patient is diagnosed with syncope and develops complications that warrant an inpatient admission. Should the patient be considered an inpatient from the time inpatient criteria are met or from the time the inpatient order is written?
A: From a regulatory perspective, hospitals cannot back date an order for admission. The inpatient admission begins at the time the order is written.
Syncope is problematic because physicians often view it as a symptom and don’t list potential underlying conditions that can cause the syncope.
The two high-risk causes of syncope that may warrant an inpatient admission are chest pain and a neurological condition. The majority of the other causes of syncope are less acute and would be more appropriate for observation.
My advice would be to ask the physician whether the syncope has a cardiac or neurogenic etiology. If it doesn’t, then it’s probably lower acuity and wouldn’t warrant an admission.
Editor’s note: Ralph Wuebker, MD, MBA, chief medical officer at Executive Health Resources in Newton Square, Pa., answered this question during HCPro’s audio conference Proactively Defend Against Recovery Auditor Prepayment Reviews.
This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
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