Patient Discharge Status Code – Definition
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).
Q: Can Patient Discharge Status Code 30, Still a Patient, be used on both inpatient and outpatient claims?
A: Yes, it can be used on both types of claims. Patient Discharge Status Code 30 should be used on inpatient claims when billing for leave of absence days, and for inpatient and outpatient interim bills. The primary method to identify that the patient is still receiving care is the bill type frequency code (e.g., Frequency Code 2: Interim – First Claim, or Frequency Code 3: Interim – Continuing Claim) Bill types ending in 2 or 3 should be reported with patient status of 30.
Key Points on Discharge status codes
• MLN Matters® article SE0801 is provided to assist providers in determining the right discharge status code to use with their claims.
• Assigning the correct patient discharge status code is just as important as any other coding used when filing a claim. 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. In cases in which two or more patient discharge status codes apply, providers 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 the provider’s claim being rejected or their claim being cancelled and payment being taken back.
• Applying the correct code will help assure that the providers receive prompt and correct payment. Patient Discharge Status Codes and Their Appropriate Use
Discharge status code list
01- Discharge to Home or Self Care (Routine Discharge)
• This code includes discharge to home; jail or law enforcement; home on oxygen if durable medical equipment (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 (LTCHs) 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, providers should 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, providers should 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 Prospective Payment System (PPS) and children’s hospitals are examples of such other types of health care institutions. New Definition for Patient Discharge Status Code 05 – Effective, per National Uniform Billing Committee (NUBC), on April 1, 2008:
• 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.
06 – Discharged/Transferred to Home Under Care of Organized Home Health Service Organization in Anticipation of Covered Skilled Care
• This code should be reported when a patient is:
• Discharged/transferred to home with a written plan of care for home care services (tailored to the patient’s medical needs) — whether home attendant, nursing aides, certified attendants, etc.;
• Discharged/transferred to a foster care facility with home care; and
• Discharged to home under a home health agency with durable medical equipment (DME).
• This code should not be used for home health services provided by a:
• DME supplier or
• Home IV provider for home IV services.
07 – Left Against Medical Advice or Discontinued Care
• The important thing to remember about this patient discharge status code is that it is to be used when a patient leaves against medical advice or the care is discontinued. According to the NUBC, discontinued services may include:
• Patients who leave before triage, or are triaged and leave without being seen by a physician; or
• Patients who move without notice, and the home health agency is unable to complete the plan of care.
08 – Reserved for National Assignment
• This patient discharge status code is reserved for national assignment.
09 – Admitted as an Inpatient to this Hospital
• This code is for use only on Medicare outpatient claims, and it applies only to those Medicare outpatient services that begin greater than three days prior to an admission.
10-19 – Reserved for National Assignment
• These patient discharge status codes are reserved for national assignment. 20 – Expired
• This code is used only when the patient dies.
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.
40 – 42 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, SNF, 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 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.
• The level of care that will be provided by the hospice upon discharge is essential to determining the proper code to use.
• NUBC clarified the following Hospice Levels of Care:
• Routine or Continuous Home Care – Patient discharge status code “50: Hospice home” should be used if the patient went to his/her own home or an alternative setting that is the patient’s “home,” such as a nursing facility, and will receive in-home hospice services;
• General Inpatient Care – Patient discharge status code “51: Hospice medical facility” should be used if the patient went to an inpatient facility that is qualified and the patient is to receive the general inpatient hospice level of care; and
• Inpatient Respite – Patient discharge status code “51: Hospice medical facility” should be used if the patient went to a facility that is qualified and the patient is receiving hospice inpatient respite level of care. Unless a patient has already been admitted to/accepted by a hospice, level of care cannot be determined. Therefore, it is recommended that if a patient is going home or to an institutional setting with a hospice “referral only” (without having already been accepted for hospice care by a hospice organization), the patient discharge status code should simply reflect the site to which the patient was discharged; not hospice (i.e., 01: home or self care, or 04: an intermediate care nursing facility, assuming it is not a Medicare SNF admission).
Additional Guidance on Use of Patient discharge status Code 50 or 51
• Patient discharge status Code 50 should be used if the patient went to his/her own home or an alternative setting that is the patient’s “home,” such as a nursing facility, and will receive in-home hospice services.
• Patient discharge status Code 51 should be used when a patient is:
• Discharged from acute hospital care but remains at the same hospital under hospice care,
• Transferred from an inpatient acute care hospital to a Medicare-certified SNF under the following conditions:
• The patient has elected the hospice benefit and will be receiving hospice care under arrangement with a hospice organization; the patient is receiving residential care only;
• The patient does not qualify for skilled level of care outside the hospice benefit for conditions unrelated to the terminal illness; and
• The patient is admitted from home (a private residence) to an acute setting. Upon discharge, the patient is transferred as a new nursing home placement to a designated hospice unit/bed.
52-60 – Reserved for National Assignment
• These patient discharge status codes are reserved for national assignment.
61 – Discharged/Transferred to a Hospital-based Medicare Approved Swing Bed
• This code is used for reporting patients discharged/transferred to a SNF level of care within the hospital’s approved swing bed arrangement.
• When a patient is discharged from an acute hospital to a Critical Access Hospital (CAH) swing bed, use patient discharge status code 61. Swing beds are not part of the post acute care transfer policy
62 – Discharged/Transferred to an Inpatient Rehabilitation Facility Including Distinct Part Units of a Hospital
• Inpatient rehabilitation facilities (or designated units) are those facilities that meet a specific requirement that 75% of their patients require intensive rehabilitative services for the treatment of certain medical conditions. This code should be used when a patient is transferred to a facility or designated unit that meets this qualification.
63 – Discharged/Transferred to Long Term Care Hospitals (LTCHs)
• This code is for hospitals that meet the Medicare criteria for LTCH certification. LTCHs are facilities that provide acute inpatient care with an average length of stay of 25 days or greater.
• This code should be used when transferring a patient to a LTCH.
• If providers are not sure whether a facility is a LTCH or a short-term care hospital, they should contact the facility to verify their facility type before assigning a patient discharge status code.
64 – Discharged/Transferred to a Nursing Facility Certified Under Medicaid but not Certified Under Medicare
• Nursing facilities may elect to certify only a portion of their beds under Medicare, and some nursing facilities choose to certify all of their beds under Medicare. Still others elect not to certify any of their beds under Medicare.
• When a patient is transferred to a nursing facility that has no Medicare certified beds, this code should be used. If any beds at the facility are Medicare certified, then the provider should use either patient discharge status code 03 or 04, depending on:
• The level of care the patient is receiving; and
• Whether the bed is Medicare certified or not.
65 – Discharged/Transferred to a Psychiatric Hospital or Psychiatric Distinct Part Unit of a Hospital
• This code should be used when a patient is transferred to an inpatient psychiatric unit or inpatient psychiatric designated unit.
Note: This code should not be used when a patient is transferred to an inpatient psychiatric unit of a federal hospital (e.g., Veterans Administration Hospitals). In this case, see Patient discharge status Code 43.
66 – Discharged/Transferred to a CAH
• Patient discharge status Code 66 is used to identify a transfer to a critical access hospital (CAH) for inpatient care. Providers will need to establish a process for identifying whether a hospital is paid under the PPS or whether the facility is designated as a CAH.
Nor transfers to a CAH swing bed should still be coded with Patient discharge status Code 61.
Correction to Patient Discharge Status Codes in Medicaid Providers Manual Information posted February 1, 2013
This is a correction to the Texas Medicaid Provider Procedures Manual (TMPPM), Volume 1, General Information, subsection 6.6.6, “Patient Discharge Status Codes.” The table in this subsection in the December 2012 and January 2013 editions of the TMPPM has the following errors:
• The table included patient discharge status codes that are not available in the TMHP claims processing system:
o 21 – Discharged/transferred to court/law enforcement
o 70 – Discharged/transferred to another type of health-care institution not defined elsewhere in the patient discharge status code table
• The table omitted patient status discharge codes that continue to be valid in the TMHP claims processing system:
o 71 – Discharge to another institution of outpatient services
o 72 – Discharged to another institution
• Some of the descriptions of the discharged status codes were changed prematurely.
Reimbursement Guidelines from UHC insurance
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);
** Skilled Nursing Claims (TOBs 18X, 21X, 22X and 23X);
** 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.