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September 29, 2014

UB-04 Discharge Status Codes

A patient discharge status code is a two-digit code entered into Form Locator (FL) 17 on the UB-04 claim form that identifies the patient's status at the conclusion of a health care facility encounter (this could be a visit or an actual inpatient stay) or at the time end of a billing cycle (the 'through' date of a claim found in FL 6 on the UB-04).

It's important to submit the correct patient status code on your claims. Omitting a code or submitting a claim with an incorrect code is a claim billing error and could result in your claim being rejected or your claim being canceled and payment being taken back.

The Centers for Medicare & Medicaid Services (CMS) requires patient status codes for:

  • Hospital Inpatient Claims (types of bill (TOBs) 11X and 12X);
  • Skilled Nursing Claims (TOBs 18X, 21X, 22X and 23X);
  • Outpatient Hospital Services (TOBs 13X, 14X, 71X, 73X, 74X, 75X, 76X and 85X)

The most current specifications for the data elements and codes included on the UB-04 claim form and the electronic HIPAA Institutional 837 Health Care Claim transaction standard is available via the National Uniform Billing Committee's Official UB-04 Data Specifications Manual on the NUBC website.

The following list is not all-inclusive: 

Code Structure
01 Discharged to home or self care (routine discharge)
02 Discharged/transferred to another short-term general hospital for inpatient care
03 Discharged/transferred to SNF in anticipation of covered skilled care
04 Discharged/transferred to a facility that provides custodial or supportive care
05 Discharged/transferred to a designated cancer center or children's hospital
06 Discharged/transferred to home health services in anticipation of covered skill care
07 Left against medical advice or discontinued  care
09 Admitted as an inpatient to this hospital
20 Patient expired
21 Discharged/transferred to court/law enforcement
30 Still a patient or expected to return for outpatient services
43 Discharged/transferred to a federal health care facility such as a VA hospital or SNF
50 Discharged/transferred to hospice at home
51 Discharged/transferred to hospice in a medical facility
61 Discharged/transferred within this institution to a hospital-based Medicare-approved swing bed
62 Discharged/transferred to an IRF including DPUs of a hospital
63 Discharged/transferred to long term care hospital
64 Discharged/transferred to Medicaid nursing facility (not Medicare certified)
65 Discharged/transferred to a psychiatric hospital or psychiatric DPU of a hospital
66 Discharged/transferred to a Critical Access Hospital
70 Discharged/transferred to another type of health care institution not defined elsewhere in the code list

Note:  The Common Working File (CWF) has edits in place for inpatient hospital claims to ensure accurate coding and payment for discharge and/or transfer policies.

Hospital claims reject when:

  • A home health claim is submitted within three days of the discharge date of a hospital claim that contains a patient's discharge status code other than 06.
  • A SNF claim is submitted within 14 days of the discharge date of a hospital claim that contains a patient's discharge status code other than 03.
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