Documentation Tip: CMS Three-Day Rule

Posted on Mon, Jul 25, 2016
Documentation Tip: CMS Three-Day Rule

Our ongoing series of documentation tips for clinicians.

By Timothy Brundage, MD

The Centers for Medicare/Medicaid Services (CMS) 3 day rule necessitates that all outpatient diagnoses and treatments are pertinent to the inpatient admission for 72 hours prior to admission.

The 3 day rule allows for the inpatient diagnosis to be made using data gathered from EMS as well as the ER evaluation.

Case Example:
Patient has documentation to support worsening shortness of breath with respiratory distress and hypoxia (81% on room air) documented in the EMS and ER records. This data supports the pulmonologist’s diagnosis of acute respiratory failure that was documented on the pulmonary consultation, treated with nebs, steroids and oxygen.  

  • The diagnosis of acute respiratory failure can be made at the time of the admission using the information obtained up to 3 days prior to admission
  • This is a valid diagnosis and should be coded and included in the inpatient DRG assignment

Dr. Timothy Brundage is a hospitalist for EmCare at St. Petersburg General Hospital in St. Petersburg, Fla. Dr. Brundage earned his bachelor’s degree in chemistry and molecular biology at the University of Michigan, his M.D. at the Wayne State University School of Medicine and completed his residency in internal medicine at the University of South Florida College of Medicine. Subscribe to Dr. Brundage’s weekly documentation tips, or ask him about specific documentation issues, by emailing him at

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