Understanding Condition Code 44 (CC44) and Condition Code W2 (CCW2)

Condition Code 44 and W2 are Medicare billing codes for hospitals to reclassify medically unnecessary inpatient stays to outpatient claims, but CC44 is for changes made before a patient is discharged, while CCW2 applies to post-discharge status changes, with different documentation and approval requirements for each scenario. 

• Timing: Used when the hospital determines the inpatient status was inappropriate before discharge. 
• Process: Requires the patient's attending physician to concur with the UR committee's decision that inpatient criteria were not met. 
• Billing: The hospital submits an outpatient claim with Condition Code 44, essentially changing the claim from Part A to Part B without the patient having to be discharged. 

• Timing: Applied when the hospital identifies the patient did not meet inpatient criteria after discharge. 
• Process: The hospital must file a "provider liable claim" within 12 months of discharge. The process requires the physician advisor and UR committee to review the case and reach a determination. 
• Billing: The hospital files a Part B claim with Condition Code W2 to receive payment for services that would have been covered as an outpatient service. 
• Outpatient Services:

  The hospital must also file separate claims for services provided as outpatient, such as emergency department visits or observation services, before the inpatient admission.

   

• Timing of Determination: Code 44 is for pre-discharge status changes, whereas W2 is for post-discharge status changes. 
• Documentation: Both require physician concurrence and UR committee review, but the process for W2 is initiated after the patient has been discharged and the initial inpatient claim denied or needing to be "self-denied". 
• Claim Type: Code 44 is on an outpatient claim, while Code W2 is a type of rebilling claim on a Part B claim to recover costs from an inappropriately billed inpatient claim.

   

• Both codes involve a physician, the patient's attending physician, and the hospital's Utilization Review (UR) committee. 
• Hospitals must provide documentation to support services provided under these conditions.