Minn. R. agency 151, ch. 5221, pt. 5221.6400 - INPATIENT HOSPITALIZATION PARAMETERS
Subpart 1.
General principles.
A. The health care provider must provide
prior notification of inpatient hospital admission for nonemergency care
according to part 5221.6050, subpart 9. Hospitalization is characterized as
inpatient if the patient spends at least one night in the hospital.
B. Treatment for emergency conditions,
including incapacitating pain, should not be delayed to provide the insurer
with prior notification. The admitting health care provider should notify the
insurer within two business days following an emergency admission, or within
two business days after the health care provider learns that it is a workers'
compensation injury. The medical necessity for the emergency hospitalization is
subject to retrospective review, based on the information available at the time
of the emergency hospitalization.
C. Unless the patient's condition requires
special care, only ward or semiprivate accommodations are indicated. The
admitting health care provider must document the special care needs.
D. Admissions before the day of surgery are
indicated only if they are medically necessary to stabilize the patient before
surgery. Admission before the day of surgery to perform any or all of a
preoperative work-up which could have been completed as an outpatient is not
indicated.
E. Inpatient
hospitalization solely for physical therapy, bedrest, or administration of
injectable drugs is indicated only if the treatment is otherwise indicated and
the patient's condition makes the patient unable to perform the activities of
daily life and participate in the patient's own treatment and
self-care.
F. Discharge from the
hospital must be at the earliest possible date consistent with proper health
care.
G. If transfer to a
convalescent center or nursing home is indicated, prior notification is
required as provided for inpatient hospitalization.
Subp. 2.
Specific requirements for
hospital admission of patients with low back pain.
Hospitalization for low back pain is indicated in the circumstances in items A to D.
A. When
the patient experiences incapacitating pain as evidenced by inability to
mobilize for activities of daily living, for example unable to ambulate to the
bathroom, and in addition, the intensity of service during admission meets the
criteria in subitems (1) and (2).
(1)
Physical therapy is necessary at least twice daily for assistance with
mobility. Heat, cold, ultrasound, and massage therapy alone do not meet this
criterion.
(2) Muscle relaxants or
narcotic analgesics are necessary intramuscularly or intravenously for a
minimum of three injections in 24 hours. Need for parenteral analgesics is
determined by:
(a) an inability to take oral
medications or diet (N.P.O.); or
(b) an inability to achieve relief with
aggressive oral analgesics.
B. For surgery which is otherwise indicated
according to part 5221.6500 and is appropriately scheduled as an inpatient
procedure.
C. For evaluation and
treatment of cauda equina syndrome, according to part 5221.6200, subpart
13.
D. For evaluation and treatment
of foot drop or progressive neurologic deficit, according to part 5221.6200,
subpart 13.
Notes
Statutory Authority: MS s 176.103; 176.83
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