Corporate

November 23, 2016

Patient Discharge Status Codes and Hospital Transfer Policies

Patient discharge status codes identify where a patient is at the conclusion of a health care facility encounter or at the end of a billing cycle.  It is important to select the correct patient discharge status code because it may affect your payment. 

Reporting incorrect patient discharge status codes may result in the following:

  • Claim denials and recoupment of payment due to a post-payment review decision
  • Claim rejections due to edits in the Fiscal Intermediary Shared System (FISS) to prevent incorrect payments
  • Inquiries to the Provider Contact Center (PCC) as a result of a claim denial or rejection to obtain the correct patient discharge status (e.g., In some cases, the patient’s status may change after leaving your facility.)

CMS published two Special Edition MLN Matters articles to provide clarifications and instructions on determining the correct patient discharge status code to use when completing your claims:

  • SE0801External PDF, “Clarification of Patient Discharge Status Codes and Hospital Transfer Policies” – Includes a subset of patient discharge status code descriptions and Frequently Asked Questions (FAQs)
  • SE1411External PDF, “Clarification of Patient Discharge Status Codes and Hospital Transfer Policies” – Includes descriptions of the hospital transfer policies

The Fiscal Year (FY) 2013 Inpatient Prospective Payment System (IPPS) Final Rule included a list of new patient discharge status codes and claim processing instructions that were never formally published in a Change Request (CR) due to its sensitive and controversial nature.  CMS recently permitted Medicare Administrative Contractors (MACs) to share the following information with the provider community.

The National Uniform Billing Committee (NUBC) approved 16 patient discharge status codes effective October 1, 2013:

Code NOT applicable to the same day transfer policy

Code

Description

Maps to Code

69

Discharged/Transferred to a Designated Disaster Alternative Care Site

01

Planned readmission codes for which the post-acute transfer policy applies

Code

Description

Maps to Code

81

Discharged to Home or Self Care with a Planned Acute Care Hospital Inpatient Readmission

01

82

Discharged/Transferred to a Short Term General Hospital for Inpatient Care with a Planned Acute Care Hospital Inpatient Readmission

02

83

Discharged/Transferred to a Skilled Nursing Facility (SNF) with Medicare Certification with a Planned Acute Care Hospital Inpatient Readmission

03

84

Discharged/Transferred to a Facility that Provides Custodial or Supportive Care with a Planned Acute Care Hospital Inpatient Readmission

04

85

Discharged/Transferred to a Designated Cancer Center or Children’s Hospital with a Planned Acute Care Hospital Inpatient Readmission

05

86

Discharged/Transferred to Home Under Care of Organized Home Health Service Organization with a Planned Acute Care Hospital Inpatient Readmission

06

87

Discharged/Transferred to Court/Law Enforcement with a Planned Acute Care Hospital Inpatient Readmission

21

88

Discharged/Transferred to a Federal Health Care Facility with a Planned Acute Care Hospital Inpatient Readmission

43

89

Discharged/Transferred to a Hospital-based Medicare Approved Swing Bed with a Planned Acute Care Hospital Inpatient Readmission

61

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

62

91

Discharged/Transferred to a Medicare Certified Long Term Care Hospital (LTCH) with a Planned Acute Care Hospital Inpatient Readmission

63

92

Discharged/Transferred to a Nursing Facility Certified Under Medicaid but not Certified Under Medicare with a Planned Acute Care Hospital Inpatient Readmission

64

93

Discharged/Transferred to a Psychiatric Hospital or Psychiatric Distinct Part Unit of a Hospital with a Planned Acute Care Hospital Inpatient Readmission

65

94

Discharged/Transferred To a Critical Access Hospital (CAH) with a Planned Acute Care Hospital Inpatient Readmission

66

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

70


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