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«MLN Matters Number: SE0801 Revised Related Change Request (CR) #: N/A Related CR Release Date: N/A Effective Date: N/A Related CR Transmittal #: N/A ...»

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The Acute Inpatient Prospective Payment System Fact Sheet (revised November 2007),

which provides general information about the Acute Inpatient Prospective Payment System

(IPPS) and how IPPS rates are set, is now available in downloadable format at

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNProducts/downloads/AcutePaymtSysfctsht.pdf from the Centers for Medicare &

Medicaid Services Medicare Learning Network. If the url above does not take you directly to

the fact sheet, please copy and paste the url in your web browser.

MLN Matters Number: SE0801 Revised Related Change Request (CR) #: N/A Related CR Release Date: N/A Effective Date: N/A Related CR Transmittal #: N/A Implementation Date: N/A Clarification of Patient Discharge Status Codes and Hospital Transfer Policies Note: This article was revised on March 6, 2014, to remove the reference to SE1411. SE1411 is being revised and will be reposted at a later date. All other information is the same.

Provider Types Affected Providers billing Medicare Fiscal Intermediaries (FIs) or Part A/B Medicare Administrative Contractors (A/B MACs).

Provider Action Needed STOP – Impact to You This Special Edition article is based on information from the Centers for Medicare & Medicaid Services (CMS) regulations and transmittals and the National Uniform Billing Committee (NUBC) Official UB-04 Data Specifications Manual 2008 (Version 2.00 July 2007) Section Form Locator 17 (Patient Discharge Status) Effective Date: March 1, 2007 copyrighted by the American Hospital Association (AHA); NUBC UB-04 Version 2.00 Clarifications and Errata (as of 8/22/07). It provides clarifications and instructions on determining the correct patient discharge status code to use when completing your claims.

IMPORTANT: The NUBC is responsible for the maintenance and dissemination of guidance for the UB-04 code set. The CMS has provided a subset of information below for Medicare-participating Disclaimer This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

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Background This Special Edition article is being provided to help you determine the right discharge status code to use with your claims. Assigning the correct patient discharge status code is just as important as any other coding used when filing a claim and the same processes should be applied for patient discharge status codes as with any other coding. Choosing the patient discharge status code correctly avoids claim errors and helps you receive payment for your claim sooner.

A patient discharge status code is a two-digit code that identifies where the patient is 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). The Centers for Medicare & Medicaid

Services (CMS) requires patient discharge status codes for:

 Hospital Inpatient Claims (type of bills (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); and  All Hospice and Home Health Claims (TOBs 32X, 33X, 34X, 81X and 82X).

It is important to select the correct patient discharge status code, and in cases in which two or more patient discharge status codes apply, you should code the highest level of care known.

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 cancelled and payment being taken back.

Applying the correct code will help assure that you receive prompt and correct payment.

Identifying the appropriate Patient discharge status Code can sometimes be confusing, so be sure to read the Frequently Asked Questions (FAQ) Section at the end of this article for further guidance.

Disclaimer This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

Page 2 of 11 MLN Matters Number: SE0801 Related Change Request Number: N/A Patient discharge status Codes and Their Appropriate Use The following describes patient discharge status codes and provides details regarding their

appropriate use:

01- Discharge to Home or Self Care (Routine Discharge) This code includes discharge to home; jail or law enforcement; home on oxygen if DME only; any other DME only; group home, foster care, and other residential care arrangements; outpatient programs, such as partial hospitalization or outpatient chemical dependency programs; assisted living facilities that are not state-designated.





02 - Discharged/Transferred to a Short-term General Hospital for Inpatient Care This patient discharge status code should be used when the patient is discharged or transferred to a short-term acute care hospital. Discharges or transfers to long-term care hospitals should be coded with Patient discharge status Code 63.

03 - Discharged/Transferred to a Skilled Nursing Facility (SNF) with Medicare Certification in Anticipation of Skilled Care.

This code indicates that the patient is discharged/transferred to a Medicare certified nursing facility in anticipation of skilled care. For hospitals with an approved swing bed arrangement, use Code 61- Swing Bed.

This code should be used regardless of whether or not the patient has skilled benefit days and regardless of whether the transferring hospital anticipates that this SNF stay will be covered by Medicare. For reporting other discharges/transfers to nursing facilities see codes 04 and 64.

Code 03 should not be used if:

 The patient is admitted to a non-Medicare certified area.

04 - Discharged/Transferred to an Intermediate Care Facility (ICF) Patient discharge status code 04 is typically defined at the state level for specifically designated

intermediate care facilities. It is also used:

 To designate patients that are discharged/transferred to a nursing facility with neither Medicare nor Medicaid certification, or  For discharges/transfers to state designated Assisted Living Facilities.

05 - Discharged/Transferred to Another Type of Health Care Institution Not Defined Elsewhere in This Code List Cancer hospitals excluded from Medicare PPS and children’s hospitals are examples of such other types of health care institutions.

Disclaimer This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

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05 - Discharged/Transferred to a Designated Cancer Center or Children’s Hospital Usage Note: Transfers to non-designated cancer hospitals should use Code 02. A list of (National Cancer Institute) Designated Cancer Centers can be found at http://cancercenters.cancer.gov/cancer_centers/cancer-centers-names.html on the Internet.

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Disclaimer This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

Page 4 of 11 MLN Matters Number: SE0801 Related Change Request Number: N/A 21-29 - Reserved for National Assignment These patient discharge status codes are reserved for national assignment.

30 - Still Patient or Expected to Return for Outpatient Services This code is used when the patient is still within the same facility and is typically used when billing for leave of absence days or interim bills. It can be used for both inpatient or outpatient claims, It is used for inpatient claims when billing for leave of absence days or interim billing (i.e., the length of stay is longer than 60 days).

On outpatient claims, the primary method to identify that the patient is still receiving care is the bill type frequency code (e.g., Frequency Code 3: Interim - Continuing Claim).

31-39 - Reserved for National Assignment These patient discharge status codes are reserved for national assignment.

Hospice Patient discharge status Codes - Hospice Claims Only (TOBs: 81X & 82X)

The following patient discharge status codes should only be used when submitting hospice claims:

 40 - Expired at Home; This code is for use only on Medicare and TRICARE claims for hospice care.

 41 - Expired in a Medical Facility, such as a Hospital, Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), or Free-standing Hospice; and  42 - Expired - Place Unknown; This code is for use only on Medicare and TRICARE claims for hospice care 43 - Discharged/Transferred to a Federal Hospital This code applies to discharges and transfers to a government operated health care facility

including:

 Department of Defense hospitals;

 Veteran's Administration hospitals; or  Veteran's Administration nursing facilities.

This patient discharge status code should be used whenever the destination at discharge is a federal health care facility, whether the patient resides there or not.

The NUBC has also clarified that this code should also be used when a patient is transferred to an inpatient psychiatric unit of a Veterans Administration (VA) hospital.

44-49 Reserved for National Assignment These patient discharge status codes are reserved for national assignment.

50 and 51 - Discharged/Transferred to a Hospice These two patient discharge status codes are used to identify when a patient is discharged or transferred to hospice care.

Disclaimer This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

–  –  –

Disclaimer This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.



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