hospital observation stay

[glm777, BSN, RN]

we admitted a resident who spent 4 days in the hospital on an observation stay - never actually admitted. He went to the hospital from home. Should I code him as admitting from community or hospital?

[Talino]

Considering duration of stay, regardless of statuts, hospital.

[MunoRN, RN]

At least for my facility that's considered an admission from the community since the patient was never admitted to the hospital. There is no "duration of stay" in a non-admitted patient.

[Talino]

Individual facilities may designate this type of admission as they wished. In the MDS world, we abide by a more stringent regulation ...

Quote

Code 01, community (private home/apt, board/care, assisted living, group home): if the resident was admitted from a private home, apartment, board and care, assisted living facility or group home.

Code 03, acute hospital: if the resident was admitted from an institution that is engaged in providing, by or under the supervision of physicians for inpatients, diagnostic services, therapeutic services for medical diagnosis, and the treatment and care of injured, disabled, or sick persons.

Rationale

Understanding the setting that the individual was in immediately prior to facility admission/entry or reentry informs care planning and may also inform discharge planning and discussions.

RAI, pp A-24, A-25

[MunoRN, RN]

On ‎6‎/‎10‎/‎2019 at 4:25 AM, Talino said:

Individual facilities may designate this type of admission as they wished. In the MDS world, we abide by a more stringent regulation ...

RAI, pp A-24, A-25

Facilities aren't actually free to designate a patient as inpatient vs observation (outpatient) as they wish, these are strictly defined designation by MDS regulations.

If you're coding a patient as having come directly from an inpatient admission, but was never coded as an inpatient, that would be a false claim.

[Talino]

Code 03 does not distinguish inpatient and observation stay in a hospital. It is used primarily for demographic tracking to assist in care planning, not reimbursement. But if you have a more specific reference to clarify the RAI, please share. We may be deviating from original poster’s question.

When in doubt, contact your state RAI Coordinator.