DISCHARGE STATUS
This field identifies the discharge status of the patient at the statement through date. This is a two-position alphanumeric field. The valid values are:
Value Description
01 Discharged to home or self-care (routine discharge)
02 Discharged/transferred to another short-term general hospital
03 Discharged/transferred to SNF
04 Discharged/transferred to an ICF
05 Discharged/transferred to another type of institution
06 Discharged/transferred to home under care of organized home health service organization
07 Left against medical advice
08 Discharged from outpatient care to be admitted to the same hospital from which the patient received outpatient services
09 Discharged from outpatient care to be admitted to the same hospital from which the patient received outpatient services
20 Expired (Or did not recover – Christian Science Patient)
30 Still a patient
40 Expired at home. For use only on Medicare hospice care claims.
41 Expired in a medical facility, i.e., hospital, SNF, ICF or freestanding hospice
42 Expired – place unknown. For use only on Medicare hospice care claims
50 Hospice – home
51 Hospice – medical facility
61 Discharged/transferred to a hospital based Medicare approved swing bed
62 Discharged/transferred to inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital.
63 Discharged/transferred to a Medicare certified long term care hospital (LTCH).
64 Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare.
64 Discharged/transferred to a psychiatric hospital or psychiatric distinct part of a hospital (effective for discharges on or after April 1, 2004).
Reimbursement Guidelines
Based on national guidelines for completing and submitting a UB-04 (or the electronic comparative) a provider must assign a Patient Discharge Status code which aligns with the type of bill (TOB) submitted.
United HealthCare Community Plan requires Patient Discharge Status codes for:
* Hospital Inpatient Claims (TOBs 11X and 12X);
* Outpatient Hospital Claims (TOBs 13X, 14X, 71X, 73X, 74X, 75X, 76X and 85X); and
* All Hospice and Home Health Claims (TOBs 32X, 33X, 34X, 81X and 82X).
The appropriate type of bill is determined based on the following guidance from the NUBC:
* The first digit is a leading zero.
* The second digit is the type of facility.
* The third digit classifies the type of care being billed.
* The fourth digit indicates the sequence of the bill for a specific episode of care. The fourth digit is
commonly referred to as the “frequency” code.
The fourth digit is indicative of the submission frequency, and should align with the Patient Discharge Status reported on the claim. A type of bill with a frequency reflective of an ongoing stay should align with a discharge status indicating that the patient is still receiving care. Additionally, a type of bill reflective of a discharge or final claim should be reported with a Patient Discharge Status that identifies where the patient is at the conclusion of a health care facility encounter, or at the end of a billing cycle (the ‘through' date of a claim).
It is important to select the correct Patient Discharge Status code. In cases in which two or more Patient Discharge Status codes apply, providers should code the highest level of care known. UnitedHealthCare Community Plan will deny claims when the Patient Discharge Status is inconsistent with the type of bill reported.
Subject:
New Patient Discharge Status Codes on UB04 claim form effective October 1, 2013
The National Uniform Billing Committee (NUBC) was formed to develop a single billing form and standard data set that could be used nationwide by institutional providers and payers for handling health care claims. The UB-04 Data Specifications Manual is the official source of data specifications adopted by the NUBC and contains codes used in the 837 Institutional electronic claims.
The Patient Status Code (Form Locator 17 on the UB04 claim form) identifies patient status as of statement covers through date and is required on all Institutional Inpatient and Outpatient claim types. Electronically, the Patient Status Code is submitted in the 2300 CL103. The NUBC has approved 16 new patient discharge codes with an effective date of October 1, 2013.
The new codes are not replacing the old codes. The new codes are to be used only if it is a planned acute care readmission sometime in the future.
New patient status code 69 (Discharged/transferred to a designated disaster alternative care site) will be added as a new code. Discharge Codes 81-95 were adapted after existing codes with "a Planned Acute Care Hospital Inpatient Readmission" is appended in the title. Readmission is defined as "An intentional readmission after discharge from an acute care hospital that is a scheduled part of the patient's plan of care."
If you have questions regarding this newsletter or the codes listed in the table below, please contact your BCBSKS Institutional Provider Representative. Denny Hartman can be reached at 1-316-269-1602, Cindy Garrison at 1-785-291-8862 and Janne Adams-Denton at 1-785-291-8813.
Current Code New Code Discharge Status Code Title
N/A 69 Discharged/Transferred to a designated disaster alternate care
01 81 Discharged to Home or Self Care with a Planned Acute. Care Hospital Inpatient Readmission
02 82 Discharged/Transferred to a Short Term General Hospital for Inpatient Care with a Planned Acute Care Hospital Inpatient Readmission
03 83 Discharged/Transferred to a Skilled Nursing Facility (SNF) with Medicare Certification with a Planned Acute Care Hospital Inpatient Readmission
04 84 Discharged/Transferred to a Facility that Provides Custodial or Supportive Care with a Planned Acute Care Hospital Inpatient Readmission
05 85 Discharged/transferred to a Designated Cancer Center or Children's Hospital with a Planned Acute Care Hospital Inpatient Readmission
06 86 Discharged/Transferred to Home under Care of Organized Home Health Service Organization with a Planned Acute Care Hospital Inpatient Readmission
21 87 Discharged/Transferred to Court/Law Enforcement with a Planned Acute Care Hospital Inpatient Readmission
43 88 Discharged/Transferred to a Federal Health Care Facility with a Planned Acute Care Hospital Inpatient Readmission
61 89 Discharged/Transferred to a Hospital-based Medicare Approved Swing Bed with a Planned Acute Care Hospital Inpatient Readmission
62 90 Discharged/Transferred to an Inpatient Rehabilitation Facility (IRF) including Rehabilitation Distinct Part Units of a Hospital with a Planned Acute Care Hospital Inpatient Readmission
63 91 Discharged/Transferred to a Medicare Certified Long Term Care Hospital (LTCH) with a Planned Acute Care Hospital Inpatient Readmission
64 92 Discharged/Transferred to a Nursing Facility Certified Under Medicaid but not Certified Under Medicare with a Planned Acute Care Hospital Inpatient Readmission
65 93 Discharged/Transferred to a Psychiatric Hospital or Psychiatric Distinct Part Unit of a Hospital with a Planned Acute Care Hospital Inpatient Readmission
66 94 Discharged/Transferred To a Critical Access Hospital (CAR) with a Planned Acute Care Hospital Inpatient Readmission
70 95 Discharged/Transferred to Another Type of Health Care Institution not Defined Elsewhere in this Code List with a Planned Acute Care Hospital Inpatient Readmission
Medicare billing Guideline
Clarification of Patient Discharge Status Codes and Hospital Transfer Policies
Note: This article was reissued on November 17, 2015 to clarify language on pages 2 and 3. All other information remains the same.
Provider Types Affected
This MLN Matters® Special Edition (SE) Article is intended for hospitals that submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.
What You Need to Know
The Office of Inspector General (OIG) conducted several reviews identifying Medicare overpayments to hospitals that did not comply with the post-acute care transfer policy. Hospitals transferred inpatients to certain post-acute care settings but coded the patient discharge status as a discharge to home. To assure proper payment under the Medicare Severity-Diagnosis Related Group (MS-DRG) payment system, hospitals must be sure to code the discharge/transfer status of patients accurately to reflect the level of post-discharge care to be received by the patient.
Background
Hospitals are responsible for coding the discharge bill based on the discharge plan for the patient, and if the hospital subsequently learns that post-acute care was provided, the hospital should submit an adjustment bill to correct the discharge status code following Medicare’s claim adjustment criteria located in the “Medicare Claims Processing Manual,”
Patient discharge status codes are part of the Official UB-04 Data Specifications Manual and are used nationwide by institutional, private, and public providers, and payers of health care claims. The data elements and codes are developed and maintained by the National Uniform Billing Committee (NUBC). To assist in the proper coding of patient discharge status code, providers may access data elements, codes, and frequently asked questions by referring to the UB-04 Data Specifications Manual. Information on obtaining a manual is located at http://www.nubc.org on the Internet.
For the purpose of discussing transfers the following terms describe when a patient leaves the hospital. Discharges and transfers under the inpatient hospital prospective payment system (IPPS) are defined in 42 CFR 412.4(a) and (b).
A “discharge” occurs when a Medicare beneficiary:
1. Leaves a Medicare IPPS acute care hospital after receiving complete acute care treatment; or
2. Dies in the hospital.
Medicare makes full MS-DRG payments to Inpatient Prospective Payment system (IPPS) hospitals when the patient is discharged to their home (Patient Discharge Status Code 01) or certain types of health care institutions (such as Patient Discharge Status Code 04 to an
Intermediate Care Facility). An “acute care transfer” occurs when a Medicare beneficiary in an IPPS hospital (with any MS-DRG) is:
1. Transferred to another acute care IPPS hospital or unit for related care - Patient Discharge Status Code 02 (or 82 when an Acute Care Hospital Inpatient Readmission is planned); or
2. Leaves against medical advice - Patient Discharge Status Code 07 but is admitted to another PPS hospital on the same day; or
3. Transferred to a hospital that would ordinarily be paid under prospective payment, but is excluded because of participation in a state or area wide cost control program - Patient Discharge Status Code 02 (or 82 when an Acute Care Hospital Inpatient Readmission is planned); or
4. Transferred to a hospital or hospital unit that has not been officially determined as being excluded from PPS such as:
a. An acute care hospital that would otherwise be eligible to be paid under the IPPS, but does not have an agreement to participate in the Medicare program (Patient Discharge Status Code 02 or 82 when an Acute Care Hospital Inpatient Readmission is planned);b. A Critical Access Hospital (Patient Discharge Status Code 66 or 94 when an Acute Care Hospital Inpatient Readmission is planned).
DISCHARGE STATUS
This field identifies the discharge status of the patient at the statement through date. This is a two-position alphanumeric field. The valid values are:
Value Description
01 Discharged to home or self-care (routine discharge)
02 Discharged/transferred to another short-term general hospital
03 Discharged/transferred to SNF
04 Discharged/transferred to an ICF
05 Discharged/transferred to another type of institution
06 Discharged/transferred to home under care of organized home health service organization
07 Left against medical advice
08 Discharged from outpatient care to be admitted to the same hospital from which the patient received outpatient services
09 Discharged from outpatient care to be admitted to the same hospital from which the patient received outpatient services
20 Expired (Or did not recover – Christian Science Patient)
30 Still a patient
40 Expired at home. For use only on Medicare hospice care claims.
41 Expired in a medical facility, i.e., hospital, SNF, ICF or freestanding hospice
42 Expired – place unknown. For use only on Medicare hospice care claims
50 Hospice – home
51 Hospice – medical facility
61 Discharged/transferred to a hospital based Medicare approved swing bed
62 Discharged/transferred to inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital.
63 Discharged/transferred to a Medicare certified long term care hospital (LTCH).
64 Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare.
64 Discharged/transferred to a psychiatric hospital or psychiatric distinct part of a hospital (effective for discharges on or after April 1, 2004).
Reimbursement Guidelines
Based on national guidelines for completing and submitting a UB-04 (or the electronic comparative) a provider must assign a Patient Discharge Status code which aligns with the type of bill (TOB) submitted.
United HealthCare Community Plan requires Patient Discharge Status codes for:
* Hospital Inpatient Claims (TOBs 11X and 12X);
* Outpatient Hospital Claims (TOBs 13X, 14X, 71X, 73X, 74X, 75X, 76X and 85X); and
* All Hospice and Home Health Claims (TOBs 32X, 33X, 34X, 81X and 82X).
The appropriate type of bill is determined based on the following guidance from the NUBC:
* The first digit is a leading zero.
* The second digit is the type of facility.
* The third digit classifies the type of care being billed.
* The fourth digit indicates the sequence of the bill for a specific episode of care. The fourth digit is
commonly referred to as the “frequency” code.
The fourth digit is indicative of the submission frequency, and should align with the Patient Discharge Status reported on the claim. A type of bill with a frequency reflective of an ongoing stay should align with a discharge status indicating that the patient is still receiving care. Additionally, a type of bill reflective of a discharge or final claim should be reported with a Patient Discharge Status that identifies where the patient is at the conclusion of a health care facility encounter, or at the end of a billing cycle (the ‘through' date of a claim).
It is important to select the correct Patient Discharge Status code. In cases in which two or more Patient Discharge Status codes apply, providers should code the highest level of care known. UnitedHealthCare Community Plan will deny claims when the Patient Discharge Status is inconsistent with the type of bill reported.
Subject:
New Patient Discharge Status Codes on UB04 claim form effective October 1, 2013
The National Uniform Billing Committee (NUBC) was formed to develop a single billing form and standard data set that could be used nationwide by institutional providers and payers for handling health care claims. The UB-04 Data Specifications Manual is the official source of data specifications adopted by the NUBC and contains codes used in the 837 Institutional electronic claims.
The Patient Status Code (Form Locator 17 on the UB04 claim form) identifies patient status as of statement covers through date and is required on all Institutional Inpatient and Outpatient claim types. Electronically, the Patient Status Code is submitted in the 2300 CL103. The NUBC has approved 16 new patient discharge codes with an effective date of October 1, 2013.
The new codes are not replacing the old codes. The new codes are to be used only if it is a planned acute care readmission sometime in the future.
New patient status code 69 (Discharged/transferred to a designated disaster alternative care site) will be added as a new code. Discharge Codes 81-95 were adapted after existing codes with "a Planned Acute Care Hospital Inpatient Readmission" is appended in the title. Readmission is defined as "An intentional readmission after discharge from an acute care hospital that is a scheduled part of the patient's plan of care."
If you have questions regarding this newsletter or the codes listed in the table below, please contact your BCBSKS Institutional Provider Representative. Denny Hartman can be reached at 1-316-269-1602, Cindy Garrison at 1-785-291-8862 and Janne Adams-Denton at 1-785-291-8813.
Current Code New Code Discharge Status Code Title
N/A 69 Discharged/Transferred to a designated disaster alternate care
01 81 Discharged to Home or Self Care with a Planned Acute. Care Hospital Inpatient Readmission
02 82 Discharged/Transferred to a Short Term General Hospital for Inpatient Care with a Planned Acute Care Hospital Inpatient Readmission
03 83 Discharged/Transferred to a Skilled Nursing Facility (SNF) with Medicare Certification with a Planned Acute Care Hospital Inpatient Readmission
04 84 Discharged/Transferred to a Facility that Provides Custodial or Supportive Care with a Planned Acute Care Hospital Inpatient Readmission
05 85 Discharged/transferred to a Designated Cancer Center or Children's Hospital with a Planned Acute Care Hospital Inpatient Readmission
06 86 Discharged/Transferred to Home under Care of Organized Home Health Service Organization with a Planned Acute Care Hospital Inpatient Readmission
21 87 Discharged/Transferred to Court/Law Enforcement with a Planned Acute Care Hospital Inpatient Readmission
43 88 Discharged/Transferred to a Federal Health Care Facility with a Planned Acute Care Hospital Inpatient Readmission
61 89 Discharged/Transferred to a Hospital-based Medicare Approved Swing Bed with a Planned Acute Care Hospital Inpatient Readmission
62 90 Discharged/Transferred to an Inpatient Rehabilitation Facility (IRF) including Rehabilitation Distinct Part Units of a Hospital with a Planned Acute Care Hospital Inpatient Readmission
63 91 Discharged/Transferred to a Medicare Certified Long Term Care Hospital (LTCH) with a Planned Acute Care Hospital Inpatient Readmission
64 92 Discharged/Transferred to a Nursing Facility Certified Under Medicaid but not Certified Under Medicare with a Planned Acute Care Hospital Inpatient Readmission
65 93 Discharged/Transferred to a Psychiatric Hospital or Psychiatric Distinct Part Unit of a Hospital with a Planned Acute Care Hospital Inpatient Readmission
66 94 Discharged/Transferred To a Critical Access Hospital (CAR) with a Planned Acute Care Hospital Inpatient Readmission
70 95 Discharged/Transferred to Another Type of Health Care Institution not Defined Elsewhere in this Code List with a Planned Acute Care Hospital Inpatient Readmission
This field identifies the discharge status of the patient at the statement through date. This is a two-position alphanumeric field. The valid values are:
Value Description
01 Discharged to home or self-care (routine discharge)
02 Discharged/transferred to another short-term general hospital
03 Discharged/transferred to SNF
04 Discharged/transferred to an ICF
05 Discharged/transferred to another type of institution
06 Discharged/transferred to home under care of organized home health service organization
07 Left against medical advice
08 Discharged from outpatient care to be admitted to the same hospital from which the patient received outpatient services
09 Discharged from outpatient care to be admitted to the same hospital from which the patient received outpatient services
20 Expired (Or did not recover – Christian Science Patient)
30 Still a patient
40 Expired at home. For use only on Medicare hospice care claims.
41 Expired in a medical facility, i.e., hospital, SNF, ICF or freestanding hospice
42 Expired – place unknown. For use only on Medicare hospice care claims
50 Hospice – home
51 Hospice – medical facility
61 Discharged/transferred to a hospital based Medicare approved swing bed
62 Discharged/transferred to inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital.
63 Discharged/transferred to a Medicare certified long term care hospital (LTCH).
64 Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare.
64 Discharged/transferred to a psychiatric hospital or psychiatric distinct part of a hospital (effective for discharges on or after April 1, 2004).
Reimbursement Guidelines
Based on national guidelines for completing and submitting a UB-04 (or the electronic comparative) a provider must assign a Patient Discharge Status code which aligns with the type of bill (TOB) submitted.
United HealthCare Community Plan requires Patient Discharge Status codes for:
* Hospital Inpatient Claims (TOBs 11X and 12X);
* Outpatient Hospital Claims (TOBs 13X, 14X, 71X, 73X, 74X, 75X, 76X and 85X); and
* All Hospice and Home Health Claims (TOBs 32X, 33X, 34X, 81X and 82X).
The appropriate type of bill is determined based on the following guidance from the NUBC:
* The first digit is a leading zero.
* The second digit is the type of facility.
* The third digit classifies the type of care being billed.
* The fourth digit indicates the sequence of the bill for a specific episode of care. The fourth digit is
commonly referred to as the “frequency” code.
The fourth digit is indicative of the submission frequency, and should align with the Patient Discharge Status reported on the claim. A type of bill with a frequency reflective of an ongoing stay should align with a discharge status indicating that the patient is still receiving care. Additionally, a type of bill reflective of a discharge or final claim should be reported with a Patient Discharge Status that identifies where the patient is at the conclusion of a health care facility encounter, or at the end of a billing cycle (the ‘through' date of a claim).
It is important to select the correct Patient Discharge Status code. In cases in which two or more Patient Discharge Status codes apply, providers should code the highest level of care known. UnitedHealthCare Community Plan will deny claims when the Patient Discharge Status is inconsistent with the type of bill reported.
Subject:
New Patient Discharge Status Codes on UB04 claim form effective October 1, 2013
The National Uniform Billing Committee (NUBC) was formed to develop a single billing form and standard data set that could be used nationwide by institutional providers and payers for handling health care claims. The UB-04 Data Specifications Manual is the official source of data specifications adopted by the NUBC and contains codes used in the 837 Institutional electronic claims.
The Patient Status Code (Form Locator 17 on the UB04 claim form) identifies patient status as of statement covers through date and is required on all Institutional Inpatient and Outpatient claim types. Electronically, the Patient Status Code is submitted in the 2300 CL103. The NUBC has approved 16 new patient discharge codes with an effective date of October 1, 2013.
The new codes are not replacing the old codes. The new codes are to be used only if it is a planned acute care readmission sometime in the future.
New patient status code 69 (Discharged/transferred to a designated disaster alternative care site) will be added as a new code. Discharge Codes 81-95 were adapted after existing codes with "a Planned Acute Care Hospital Inpatient Readmission" is appended in the title. Readmission is defined as "An intentional readmission after discharge from an acute care hospital that is a scheduled part of the patient's plan of care."
If you have questions regarding this newsletter or the codes listed in the table below, please contact your BCBSKS Institutional Provider Representative. Denny Hartman can be reached at 1-316-269-1602, Cindy Garrison at 1-785-291-8862 and Janne Adams-Denton at 1-785-291-8813.
Current Code New Code Discharge Status Code Title
N/A 69 Discharged/Transferred to a designated disaster alternate care
01 81 Discharged to Home or Self Care with a Planned Acute. Care Hospital Inpatient Readmission
02 82 Discharged/Transferred to a Short Term General Hospital for Inpatient Care with a Planned Acute Care Hospital Inpatient Readmission
03 83 Discharged/Transferred to a Skilled Nursing Facility (SNF) with Medicare Certification with a Planned Acute Care Hospital Inpatient Readmission
04 84 Discharged/Transferred to a Facility that Provides Custodial or Supportive Care with a Planned Acute Care Hospital Inpatient Readmission
05 85 Discharged/transferred to a Designated Cancer Center or Children's Hospital with a Planned Acute Care Hospital Inpatient Readmission
06 86 Discharged/Transferred to Home under Care of Organized Home Health Service Organization with a Planned Acute Care Hospital Inpatient Readmission
21 87 Discharged/Transferred to Court/Law Enforcement with a Planned Acute Care Hospital Inpatient Readmission
43 88 Discharged/Transferred to a Federal Health Care Facility with a Planned Acute Care Hospital Inpatient Readmission
61 89 Discharged/Transferred to a Hospital-based Medicare Approved Swing Bed with a Planned Acute Care Hospital Inpatient Readmission
62 90 Discharged/Transferred to an Inpatient Rehabilitation Facility (IRF) including Rehabilitation Distinct Part Units of a Hospital with a Planned Acute Care Hospital Inpatient Readmission
63 91 Discharged/Transferred to a Medicare Certified Long Term Care Hospital (LTCH) with a Planned Acute Care Hospital Inpatient Readmission
64 92 Discharged/Transferred to a Nursing Facility Certified Under Medicaid but not Certified Under Medicare with a Planned Acute Care Hospital Inpatient Readmission
65 93 Discharged/Transferred to a Psychiatric Hospital or Psychiatric Distinct Part Unit of a Hospital with a Planned Acute Care Hospital Inpatient Readmission
66 94 Discharged/Transferred To a Critical Access Hospital (CAR) with a Planned Acute Care Hospital Inpatient Readmission
70 95 Discharged/Transferred to Another Type of Health Care Institution not Defined Elsewhere in this Code List with a Planned Acute Care Hospital Inpatient Readmission
Medicare billing Guideline
Clarification of Patient Discharge Status Codes and Hospital Transfer Policies
Note: This article was reissued on November 17, 2015 to clarify language on pages 2 and 3. All other information remains the same.
Provider Types Affected
This MLN Matters® Special Edition (SE) Article is intended for hospitals that submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.
What You Need to Know
The Office of Inspector General (OIG) conducted several reviews identifying Medicare overpayments to hospitals that did not comply with the post-acute care transfer policy. Hospitals transferred inpatients to certain post-acute care settings but coded the patient discharge status as a discharge to home. To assure proper payment under the Medicare Severity-Diagnosis Related Group (MS-DRG) payment system, hospitals must be sure to code the discharge/transfer status of patients accurately to reflect the level of post-discharge care to be received by the patient.
Background
Hospitals are responsible for coding the discharge bill based on the discharge plan for the patient, and if the hospital subsequently learns that post-acute care was provided, the hospital should submit an adjustment bill to correct the discharge status code following Medicare’s claim adjustment criteria located in the “Medicare Claims Processing Manual,”
Patient discharge status codes are part of the Official UB-04 Data Specifications Manual and are used nationwide by institutional, private, and public providers, and payers of health care claims. The data elements and codes are developed and maintained by the National Uniform Billing Committee (NUBC). To assist in the proper coding of patient discharge status code, providers may access data elements, codes, and frequently asked questions by referring to the UB-04 Data Specifications Manual. Information on obtaining a manual is located at http://www.nubc.org on the Internet.
For the purpose of discussing transfers the following terms describe when a patient leaves the hospital. Discharges and transfers under the inpatient hospital prospective payment system (IPPS) are defined in 42 CFR 412.4(a) and (b).
A “discharge” occurs when a Medicare beneficiary:
1. Leaves a Medicare IPPS acute care hospital after receiving complete acute care treatment; or
2. Dies in the hospital.
Medicare makes full MS-DRG payments to Inpatient Prospective Payment system (IPPS) hospitals when the patient is discharged to their home (Patient Discharge Status Code 01) or certain types of health care institutions (such as Patient Discharge Status Code 04 to an
Intermediate Care Facility). An “acute care transfer” occurs when a Medicare beneficiary in an IPPS hospital (with any MS-DRG) is:
1. Transferred to another acute care IPPS hospital or unit for related care - Patient Discharge Status Code 02 (or 82 when an Acute Care Hospital Inpatient Readmission is planned); or
2. Leaves against medical advice - Patient Discharge Status Code 07 but is admitted to another PPS hospital on the same day; or
3. Transferred to a hospital that would ordinarily be paid under prospective payment, but is excluded because of participation in a state or area wide cost control program - Patient Discharge Status Code 02 (or 82 when an Acute Care Hospital Inpatient Readmission is planned); or
4. Transferred to a hospital or hospital unit that has not been officially determined as being excluded from PPS such as:
a. An acute care hospital that would otherwise be eligible to be paid under the IPPS, but does not have an agreement to participate in the Medicare program (Patient Discharge Status Code 02 or 82 when an Acute Care Hospital Inpatient Readmission is planned);
b. A Critical Access Hospital (Patient Discharge Status Code 66 or 94 when an Acute Care Hospital Inpatient Readmission is planned).
References:
[1] NUBC Uniform Billing (UB-04) Patient Discharge Status (FL17/CL103) - HL7 Confluence. Retrieved from [1]
[2] Patient Discharge Status Codes - JF Part A - Noridian. Retrieved from [2]
http://www.cms1500claimbilling.com/2016/01/ub-04-medicare-discharge-status-code.html