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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.




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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