PATIENT TYPE CODES

1. Why is it so important that I enter the correct code? PATIENT TYPE CODES

2. Introduction • In this module you will learn in simple terms why Pt Type codes are so important. • You will also learn when you will use certain codes when transferring patients into your unit and when you will change a Patient Type Code. • But first of all you will need to know the questions you need to answer to determine which Patient Type Code you will use.

3. Is the patient a “Private Room” Request? • Has the patient specifically asked for a private room and is willing to pay? • This “Patient Type” would be “P”. The patient’s insurance will pay for the semi-private rate and the patient will pay the difference between the semi-private rate and the private room rate. • If the patient is a “Private Room” request, but the patient is considered a “Medical Necessity”, then the insurance will cover the cost for the private room. The “Patient Type” will be “J”. An example of medical necessity is a patient on precautions.

4. Does the patient want a semi-private room? • When a patient has requested a semi-private room and none are available, they would be placed in a private room but would not be required to pay. This patient would be Pt Type “Z”(Hospital Convenience). If a semi-private becomes available, the patient may have to move or will be asked to begin paying for the private room. • Patients that are put in a private room due to the fact that the area they are admitted to has only private rooms, may also be Pt Type “Z” (Hospital Convenience). Examples: JA4, 6A. • However if they are a “Private Request” patient or a “Medical Necessity” that takes priority and the patient is a “P” or “J”.

5. Intensive Care + Step Down • Patients admitted to an intensive care unit and are considered “intensive level of care” will have a patient type “I”, (“C” on CCU). Patients admitted to a step down unit and are considered “intermediate level of care” will have a patient type “V”.

6. Changing the Pt Type • Once the patient’s level of care changes then the “Pt Type” must be changed to match that change. • For example: an order is written on a patient in any of the ICUs to transfer a patient to a “Step Down” unit. Therefore that patient becomes a “step down” level of care patient and the “Pt Type” must be changed to “V” for intermediate (step down) level of care. • If there is not a bed available on a “Step Down” unit and the patient remains on ICU, the insurance companies will only pay the intermediate rate. Therefore, the “Pt Type” must be changed to “V”.

7. Changing the Pt Type and Observation Patients • When a patient on an ICU or Step Down has an order to transfer to a general medical or surgical unit that patient type needs to be changed to a “Y” for border. The patient type remains “Y” until the patient is moved to a general unit. • If there are no general unit beds available and a patient is admitted to an intermediate/step down unit but is not a step down level of care patient, that patient would be a patient type, “Y”, border. • Observation patients are patient type “E”, “F”, or “G”. Observation patients cannot be changed to any other patient type code until they are changed to “Inpatient”.

8. Where to Get More Information • More information can be found on the “Patient Services” website. Look in “Information”. There you will find a complete list of all the “Pt Types” and when they are used. • You can also “right” click in the “Pt Type” field on the “Transfer” screen and click on “Help”. This will bring up a listing of all the Pt Types.

9. Conclusion-Why is “Pt Type” so Important? • Can affect patient financially as they may be billed for something their insurance company should pay. • A huge impact financially on the hospital, the patient, and the insurance companies.