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Patient Discharge Status Codes and Hospital Transfer Policies - Clarification
October 24, 2014
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 or at the end time of a billing cycle. It belongs in Form Locator 17 on a UB-04 claim form or its electronic equivalent in the HIPAA compliant 837 format.
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)
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.
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