1. Why is it so important that I enter the correct code? 5/12/20151

2.  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. 5/12/20152

3.  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. 5/12/20153

4.  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”. 5/12/20154

5.  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”. 5/12/20155

6.  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”. 5/12/20156

7.  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”. 5/12/20157

8.  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. 5/12/20158

9.  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. 5/12/20159