Certified Inpatient Coding (CIC) Practice Exam

Which statement about Condition Code 44 is true?

1. It can only be applied if the physician changes patient status from inpatient to outpatient prior to discharge.

2. The use of Condition Code 44 can be based solely on the physician's documentation of the order.

3. Medicare will not pay for any Part B services furnished to an inpatient when not medically necessary.

4. Condition Code 44 is reported on the outpatient claim.

The correct answer is: Medicare will not pay for any Part B services furnished to an inpatient when not medically necessary.

The statement regarding Condition Code 44 that is accurate relates to the specifics of Medicare billing requirements, particularly the context in which services provided to patients are considered medically necessary. When a patient is classified as an inpatient, Medicare expects that all services rendered during their stay will be medically necessary for their diagnosis or treatment. If it is determined that the services rendered do not meet this necessity, Medicare will not provide reimbursement for those services under Part B. Condition Code 44 allows for a situation where a physician decides that the patient's status should be changed—from inpatient to outpatient status—due to an assessment made after admission. However, this process can only influence the status change and does not directly alter the fundamental Medicare policies regarding payment for services deemed unnecessary for the patient's care. This understanding ties directly to the nature of how Medicare operates regarding inpatient care and what standards they set for reimbursement. Thus, the correct choice connects Condition Code 44 and the critical concept of medical necessity as defined by Medicare guidelines.