Q: Our facility has a question about how other hospitals address this scenario:
Patient is discharged to home (discharge status code 01). No documentation exists in the medical record to support post-acute care. Several months later, our Medicare Administrative Contractor (MAC) notifies us that the patient indeed went to post-acute care after discharge. The MAC retracts our entire payment.
We need to resubmit the claim with the correct discharge status code. We are reluctant to do so because nothing in the medical record supports the post-acute care provided. Are other hospitals amending the record? If so, what department is adding the amended note?
A: To answer this question completely, I would need access to the records in question. However, I will do my best to provide some guidance.
First, call your MAC to determine the reason for the change in discharge status. Second, confirm with the transfer facility that the patient did, in fact, receive post-acute care. Finally, amend the health record to reflect the change in discharge status.
Patients are commonly discharged home and unexpectedly receive home health after a physician decides after discharge that they need the services. This results in discharge status code 06—not 01.
However, sometimes the MAC is wrong. For example, this can occur when patients may have already been in an episode of home health care prior to hospitalization. When these patients resume home health care more than three days after hospital discharge, a MAC may incorrectly identify discharge status code 01 as erroneous.
Editor’s note: William E. Haik, MD, FCCP, CDIP, director of DRG Review, Inc. in Fort Walton Beach, FL, answered this question.
This answer was provided based on limited information submitted to JustCoding. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
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