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Observation vs Admission

Page history last edited by Lenny 10 years, 10 months ago

Who to "Place in observation status" or "Admit to Obs"

 

1. Expected dc within 24-48hrs based on initial evaluation by admitting provider (housestaff, APP or attending)

2. Unsure whether to admit patient

 Examples: mild asthma exac, low risk cp, abd pain c wbc 11

 

E/M codes:

1st day seen:  218-220

2nd day as obs: 211-215

obs dc: 217

 

 

Notes:  Obs/Admit status can be changed in either direction.  Ask RN Case Manager or search "Interqual Criteria" for more info.

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Who to "Admit"

1. Everyone else

2. Patients meeting SIRS criteria

3. Day 2 of observation, not going home: "Change to Inpatient Status"

Examples: alcohol withdrawl, found down in bus station, Obs for abd pain develops contrast nephropathy, HAP and C. diff on day 2.

 

E/M codes:

1st day seen: 221-223

2nd day inpt: 231-233

Inpt DC: 238-239

 

Case of Change to Inpatient status

1st day Obs: 218-220

2nd day "Change to Inpt": 223 [include "PFSH, ROS unchanged from H&P dated  /  /"]

Inpt DC: 238-239

 

Case of "Pt sent home before we knew it"

Intern admits at 11pm

Attending sees at 8:30am next day

Discharged on the only day the attending saw the patient: 234-236.

This is correct for "Place in obs" or "Admit to Turquoise Medicine" scenarios.

 

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