Can I use Z-codes to change the status of a patient to Alternate Level of Care?

Question: Can I enter Z-codes to indicate the barriers to discharge that cause my patient to remain in hospital as an Alternate Level of Care (ALC) patient?

Context: When inpatients no longer need the intensity of care or level of service provided by their admitting acute care facility, it is important for the Most Responsible Provider (MRP, usually the attending prescriber) to change their "patient status" to "Alternate Level of Care" (ALC). The ALC designation effectively stops the clock measuring a patient's actual length of stay (LOS). Recognizing when medical management has finished and switching to ALC status is among meaningful use norms expected of prescribers.

The easiest way to make changes to the inpatient status is to use the "Level of Care" column in patient lists. This is built-in to the Rapid Rounds patient list template. Double-clicking on the LOC row value for a patient opens a pop-up editing tool where the "ALC - TBD" button should be used.

Prescribers can also initiate an ALC status using the "Orders" activity, by using an "Initiate ALC" order or a "Patient Status" order, then using the "ALC - TBD" speed button. 

It is important that prescribers ONLY select "ALC - TBD" and not Z-codes. Transition coordinators and/or nursing staff take care of more detailed (Z-code) ALC statuses. Selecting Z-codes too early can trigger direct charges to the patient.

  • Note: If a patient already has an ALC status and an "Initiate ALC" order is entered with "ALC - TBD" selected, any Z-codes assigned to that patient will be overwritten.

Answer: To change the status of a patient to Alternate Level of Care, the MRP should use the "Level of Care" patient list column or enter an "Initiate ALC" order. Either way, it is important to use the "ALC - TBD" quick-button, and to NOT select ALC statuses with Z-codes. Prescribers can document barriers to discharge using the Expected Date of Discharge (EDD) comment field and the Discharge Planning report built-in to the inpatient sidebar.

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