^A07
ADT^A07 — Change Inpatient to Outpatient
Sent when a patient's status changes from inpatient to outpatient. This is the reverse of ADT^A06. The encounter class is downgraded and the inpatient bed is released. Used when a full inpatient admission is reclassified as outpatient or observation status.
When Is This Sent?
When an inpatient admission is reclassified as outpatient or observation — for example, due to a utilization review decision that the admission does not meet inpatient criteria. PV1.2 changes from I to O.
Real-World Usage
A07 is operationally important for billing accuracy. Inpatient vs outpatient classification has significant reimbursement implications under Medicare and commercial payers. If A07 is not properly distributed, the billing system will continue to bill at inpatient rates after the reclassification, resulting in claim denials or overpayment.
Message Structure
Segment names link to their field-level reference pages.
| # | Segment | Purpose in this message | Req | Repeat |
|---|---|---|---|---|
| 1 | MSH | Message header with ADT^A07 in MSH.9 | R | — |
| 2 | EVN | Event type with A07 trigger and reclassification timestamp | R | — |
| 3 | PID | Patient demographics | R | — |
| 4 | MRG | Prior inpatient visit identifier being superseded | R | — |
| 5 | PV1 | Updated visit information with PV1.2=O (outpatient) or R (recurring) | R | — |
| 6 | PV2 | Extended visit details including reclassification reason | O | — |
| 7 | DG1 | Updated diagnosis after reclassification | O | Yes |
Example Message
Realistic example with fake patient data. Paste into the HL7 Message Viewer to explore interactively.
1MSH||^~\&|EPIC|HOSPITAL_A|MIRTH_PROD|BILLING|20260311120000||ADT^A07^ADT_A07|MSG00040|P|2.5.1 2EVN||A07|20260311120000 3PID||1||123456^^^HOSP_A^MR||Smith^John^M^^Mr.||19850315|M 4MRG||123456^^^HOSP_A^MR||VIS20260310001^HOSP_A 5PV1||1|O|4A^201^1^^^HOSP_A||||1234^Ahmed^Dr.^Khalid|||MED|||||OBS|||5678^Wilson^Dr.^Sarah|OP||||||||||||||||||||||||||20260310143000
Troubleshooting Scenarios
Billing system still processing at inpatient rate after A07 reclassification
Cause
A07 was not distributed to the billing system, or the billing system does not process A07 events.
Fix
Verify A07 is in the billing interface's event subscription. Confirm with the billing system vendor that A07 triggers a patient class update. If not supported, a manual correction may be needed in the billing system.
Common Confusions
ADT^A07 (Inpatient to Outpatient) vs ADT^A03 (Discharge). A07 changes the patient class while keeping the encounter active. A03 ends the encounter entirely. Use A07 when the patient is still receiving care but the billing classification has changed; use A03 when the patient is leaving the facility.
Related Message Types
Segment Reference
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