Before sharing sensitive information, make sure youre on a federal government site. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. This code is used for reporting patients discharged/transferred to a SNF level of care within the hospitals approved swing bed arrangement. 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. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. To sign up for updates or to access your subscriber preferences, please enter your contact information below. The .gov means its official. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". Clarification of Patient Discharge Status Codes and Hospital Transfer Policies. o 72 Discharged to another institution You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. means youve safely connected to the .gov website. The same processes should be applied for patient discharge status codes as with any other coding. Assigning the correct patient discharge status code is just as important as any other coding used when filing a claim. Additional Guidance on Use of Patient discharge status Code 50 or 51. The 2023 ICD-10-CM files below contain information on the ICD-10-CM updates for FY 2023. 44-49 Reserved for National Assignment New Patient Discharge Status Code 21 to Define Discharges or Transfers to Court/Law Enforcement This article is based on Change Request (CR) 6385 which This patient discharge status code should be used when the patient is discharged or transferred to a short-term acute care hospital. You, your employees and agents are authorized to use CPT only as contained in the following authorized materials: Local Coverage Determinations (LCDs), training material, publications, and Medicare guidelines, internally within your organization within the United States for the sole use by yourself, employees and agents. 0000008274 00000 n
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; Transferred to a hospital or hospital unit that hasnt been officially determined as being excluded from IPPS such as: An acute care hospital that would otherwise be eligible to be paid under the IPPS, but doesnt have an agreement to participate in the Medicare Program (Patient Discharge Status Code 02 or Planned Acute Care Hospital Inpatient Readmission Patient Status Code 82), A Critical Access Hospital (Patient Discharge Status Code 66 or Planned Acute Care Hospital Inpatient Readmission Patient Status Code 94). Web 482.43 Condition of participation: Discharge planning. Discharge Disposition code 2 - Patient discharged from agency (with formal assistive services). These codes are important in understanding the discharge status as reported to CMS by the hospital and may impact post-acute Medicare Part A coverage in the skilled nursing facility and home care. 03 Discharged/Transferred to a Skilled Nursing Facility (SNF) with Medicare Certification in Anticipation of Skilled Care All Rights Reserved to AMA. These patient discharge status codes are reserved for national assignment. The Department may not cite, use, or rely on any guidance that is not posted Clinical Focus: This value set contains concepts that represent a patient leaving against medical advice. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. 0000011314 00000 n
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New Patient Discharge Status Code 21 to Define Discharges or Transfers to Court/Law Enforcement. Secure .gov websites use HTTPSA Patient has WC and Medicare insurance? 08. WebRefer an Agencyand get up to $2,500! The Centers for Medicare and Medicaid Services (CMS) issued two Medlearn Matters articles under the heading of Clarification of Patient Discharge Status Codes and Hospital Transfer Policies and numbered SE0801 and SE1411. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). 20 Expired CDT is a trademark of the ADA. In cases in which two or more patient discharge status codes apply, providers should code the highest level of care known. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. There are times in which the various content contributor primary resources are not synchronized or updated on the same time interval. ** The first digit is a leading zero. 812 0 obj
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40 42 Hospice Patient discharge status Codes Hospice Claims Only (TOBs: 81X & 82X) 0000006647 00000 n
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Patients who leave before triage, or are triaged and leave without being seen by a physician; or 0000014767 00000 n
U.S. Department of Health & Human Services Heres how you know. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 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. BY CLICKING ABOVE ON THE LINK LABELED "I Accept", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THESE AGREEMENTS. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. This license will terminate upon notice to you if you violate the terms of this license. endstream
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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. The patient is admitted from home (a private residence) to an acute setting. No fee schedules, basic unit, relative values or related listings are included in CDT-4. Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, Medicare revalidation process how often provide need to do FAQ, Step by step Guide Medicare participation program. Warning: you are accessing an information system that may be a U.S. Government information system. 0000014725 00000 n
We made the GEMs files available for FY 2016, FY 2017 and FY 2018. Receive Medicare's "Latest Updates" each week. It can be used for both inpatient or outpatient claims. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CPT codes, descriptions and other data only are copyright 2002-2020 American Medical Association (AMA). An official website of the United States government. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Patient discharge status Code 50 should be used if the patient went to his/her own home or an alternative setting that is the patients home, such as a nursing facility, and will receive in-home hospice services. IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. 0
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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. 518.867.8384 fax, Assisted Living and Adult Care Facilities. o 21 Discharged/transferred to court/law enforcement You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. 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. J\6]q%" =H4$ 0ASR`>^^3/[m 0
c6zA9l4y63Ma;$e:|re@|^p&-DF "SJQ:EnVuSu^w4_k+8m69)36:/#(%M^a,5PIhC!CXH(o59ZVm}MkWy?8' Discharges or transfers to long-term care hospitals (LTCHs) should be coded with Patient discharge status Code 63. 3. Before sharing sensitive information, make sure youre on a federal government site. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. AMA Disclaimer of Warranties and Liabilities This warning banner provides privacy and security notices consistent with applicable federal laws, directives, and other federal guidance for accessing this Government system, which includes all devices/storage media attached to this system. on the guidance repository, except to establish historical facts. 0000001731 00000 n
Toll Free Call Center: 1-877-696-6775. 0000048901 00000 n
DISCLAIMER: The contents of this database lack the force and effect of law, except as Veterans Administration nursing facilities. 62 Discharged/Transferred to an Inpatient Rehabilitation Facility Including Distinct Part Units of a Hospital AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. Code Description 69 Discharges/transfers to a Designated Disaster Alternative Care Site, NEW READMISSION PATIENT DISCHARGE STATUS CODES, Discharged/Transferred to a Skilled Nursing Facility (SNF) with Medicare Certification with a Planned Acute Care Hospital Inpatient Readmission, Discharged/Transferred to Home Under Care of Organized Home Health Service Organization with a Planned Acute Care Hospital Inpatient Readmission, (Source: CMS Medlearn Matters article SE1411). Race/Ethnicity: In 2021, 30,161 White patients were discharged to hospice, more than for other Race/Ethnicity groups. DISCLAIMER: The contents of this database lack the force and effect of law, except as Assigning the correct patient discharge AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. 09. Washington, D.C. 20201 Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. The discharge status code identifies where the patient is being discharged to at the end of their facility stay or transferred to such as an acute/post-acute facility. The discharging facility should ensure that documentation in the patients medical record supports the billed discharge status code. This includes items such as CPT codes, CDT codes, ICD-10 and other UB-04 codes. Some of the Provider information contained on the Noridian Medicare web site is copyrighted by the American Medical Association, the American Dental Association, and/or the American Hospital Association. 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). The table omitted patient status discharge codes that continue to be valid in the TMHP claims processing system: 812 25
Please click here to see all U.S. Government Rights Provisions. o 70 Discharged/transferred to another type of health-care institution not defined elsewhere in the patient discharge status code table The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. The CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. website belongs to an official government organization in the United States. According to the NUBC, discontinued services may include: The disposition, or location to which the patient is transferred at the time of hospital discharge.
The following patient discharge status codes should only be used when submitting hospice claims: 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. This license will terminate upon notice to you if you violate the terms of this license. In the past, HCAI adjusted the grouper and applied it to records based on a calendar year. No fee schedules, basic unit, relative values or related listings are included in CDT. To designate patients that are discharged/transferred to a nursing facility with neither Medicare nor Medicaid certification, or Webwhich tools would you use to make header 1 look like header 2 These patient discharge status codes are reserved for national assignment. A discharge occurs when a Medicare patient: An acute care transfer occurs when a Medicare patient in an IPPS hospital (with any MSDRG) is: click here to see all U.S. Government Rights Provisions, CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 1, CMS Medicare Claims Processing Manual (Pub. Nor transfers to a CAH swing bed should still be coded with Patient discharge status Code 61. 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. This code indicates that the patient is discharged/transferred to a Medicare-certified nursing facility in anticipation of skilled care. The latest ones are on May 30, 2021 11 new Cms Discharge Disposition Code List results have been found in the last 90 days, which means that every 9, a new Monday to Friday. 0000007758 00000 n
The scope of this license is determined by the ADA, the copyright holder. THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. This code should be used when transferring a patient to a LTCH. The AMA does not directly or indirectly practice medicine or dispense medical services. No fee schedules, basic unit, relative values or related listings are included in CPT. xref
Rolling Stone Media Kit 2021; National Verifier Ebb Number; Tenerife Airport Disaster Bodies; Stellaris: Console Edition Unauthorized or improper use of this system is prohibited and may result in disciplinary action and/or civil and criminal penalties. incorporated into a contract. startxref
Patients who move without notice, and the home health agency is unable to complete the plan of care. Omitting a code or submitting a claim with an incorrect code is a claim billing error and could result in the providers claim being rejected or their claim being cancelled and payment being taken back. trailer
63 Discharged/Transferred to Long Term Care Hospitals (LTCHs) Cancer hospitals excluded from Medicare Prospective Payment System (PPS) and childrens hospitals are examples of such other types of health care institutions. Share sensitive information only on official, secure websites. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. 0000001136 00000 n
There is no FY 2023 GEMs file. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. 30 Still Patient or Expected to Return for Outpatient Services On September 26, 2019, the Centers for Medicare and Medicare Services (CMS) released the final rule on discharge planning requirements (the Final Rule) in an effort to empower patients to be active participants in the discharge planning process. 07. Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming, Last Updated Tue, 18 Jan 2022 20:55:43 +0000. WebCMS 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 If any beds at the facility are Medicare certified, then the provider should use either patient discharge status code 03 or 04, depending on: Issued by: Centers for Medicare & Medicaid Services (CMS). LICENSE FOR NATIONAL UNIFORM BILLING COMMITTEE ("NUBC"), Point and Click American Hospital Association Copyright Notice, Copyright 2021, the American Hospital Association, Chicago, Illinois. 0000014662 00000 n
This system is provided for Government authorized use only. Discharged/transferred to a designated cancer center or children's hospital. Web5764.1 Medicare systems shall accept patient discharge status code 70. This is the current published version. 0000002819 00000 n
IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK ABOVE ON THE LINK LABELED "I Do Not Accept" AND EXIT FROM THIS COMPUTER SCREEN. If the first hospital was unaware of the planned admission at the second hospital, its likely the first hospital will have to adjust the previously submitted claim to correct the patient discharge status code to indicate a transfer (02), which reflects where the patient was later admitted on the same date. 0000092313 00000 n
The AMA does not directly or indirectly practice medicine or dispense medical services. Latham, NY 12110
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Bs@(P4G@{ - The ADA does not directly or indirectly practice medicine or dispense dental services. 05. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. The scope of this license is determined by the ADA, the copyright holder. The AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. %%EOF
Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827, 13 British American Blvd Suite 2
Last Updated: Jul 08, 2021 Before you can enter the Noridian Medicare site, please read and accept an agreement to abide by the copyright rules regarding the information you find within this site. or transfers to court/law enforcement. These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright 2002, 2004 American Dental Association (ADA). The site is secure. The National Uniform Billing Committee (NUBC) develops and maintains the data elements and codes. 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 Childrens Hospital Usage Note: Transfers to non-designated cancer hospitals should use Code 02. 05 Discharged/Transferred to Another Type of Health Care Institution Not Defined Elsewhere in This Code List
if(pathArray[4]){document.getElementById("usprov").href="/web/"+pathArray[4]+"/help/us-government-rights";} 06 Discharged/Transferred to Home Under Care of Organized Home Health Service Organization in Anticipation of Covered Skilled Care. If this is a U.S. Government information system, CMS maintains ownership and responsibility for its computer systems. 0000006792 00000 n
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). 0000003479 00000 n
This will prevent incorrect billing of the Discharge Status Code and avoid unnecessary adjustments to claims when the incorrect code is used. %PDF-1.4
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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. Discharged to home under a home health agency with durable medical equipment (DME). Making copies or utilizing the content of the UB-04 Manual or UB-04 Data File, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual / Data File or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. THE LICENSES GRANTED HEREIN ARE EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THESE AGREEMENTS. For hospitals with an approved swing bed arrangement, providers should use Code 61- Swing Bed. Choosing the patient discharge status code correctly avoids claim errors and helps you receive payment for your claim sooner. `U~F+$4h Applying the correct code will help assure that the providers receive prompt and correct payment. Discharged from acute hospital care but remains at the same hospital under hospice care, The ADA is a third-party beneficiary to this Agreement. CMS Disclaimer AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. 0000002491 00000 n
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CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. ). This code is for hospitals that meet the Medicare criteria for LTCH certification. ( Click here to review the rule in the Federal Register.) The CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. The recent CMS discharge planning rule that went into effect in November 2019 included several changes aimed at improving care transitions and encouraging patients involvement in their follow-up treatment and care protocols. 8AM - 4:30PM. 0000109996 00000 n
2. 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). The fourth digit is indicative of the submission frequency, and should align with the Patient Discharge Status reported on the claim. https:// Issued by: Centers for Medicare & Medicaid Services (CMS). endstream
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Patient Discharge Status Code Definition. 0000047974 00000 n
; It is important to select the correct patient discharge status code. %%EOF
Applications are available at the American Dental Association web site, http://www.ADA.org. Discharged/transferred to a facility that provides custodial or supportive care. 100-04), Chapter 3, 26 Century Blvd Ste ST610, Nashville, TN 37214-3685. These materials contain Current Dental Terminology, (CDT), copyright 2020 American Dental Association (ADA). These patient discharge status codes are reserved for national assignment. This sdtc:dischargeDispositionCode SHOULD contain exactly [0..1] code, which SHOULD be selected from ValueSet 2.16.840.1.113883.3.88.12.80.33 NUBC UB-04 FL17-Patient Status You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. 0
NUBC clarified the following Hospice Levels of Care: WebC-CDA Not much help. ** Skilled Nursing Claims (TOBs 18X, 21X, 22X and 23X); Reserved for national assignment. The hospital must have an effective discharge planning process that focuses on the patient's goals and treatment preferences and includes the patient and his or her caregivers/support person(s) as active partners in the discharge planning for post-discharge care. In an effort to better enable the collection of health-related social needs (HRSNs), defined as individual-level, adverse social conditions that negatively impact a persons health or healthcare, are significant risk factors associated with worse health outcomes as well as increased healthcare utilization, the Centers for Disease Control and Preventions (CDC) National Center for Health Statistics (NCHS) is implementing 42 new diagnosis codes into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), for reporting effective April 1, 2023. Correction to Patient Discharge Status Codes in Medicaid Providers Manual Information posted February 1, 2013. A federal government website managed by the 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). M >g:V
Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. The patient does not qualify for skilled level of care outside the hospice benefit for conditions unrelated to the terminal illness; and Webadjustment bill to correct the discharge status code following Medicares claim adjustment criteria located in the Medicare Claims Processing Manual, Chapter 1, Section 130.1.1 To license the electronic data file of UB-04 Data Specifications, contact AHA at (312) 893-6816. The ADA is a third-party beneficiary to this Agreement. Hospitals transferred inpatients to certain post-acute care settings but coded the patient discharge status as a discharge to home. The scope of this license is determined by the AMA, the copyright holder. The AMA is a third-party beneficiary to this license. authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically 0000004018 00000 n
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. CMS DISCLAIMER. intermediate care facilities. The use of the information system establishes user's consent to any and all monitoring and recording of their activities. hmo0^P?]&
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hb```b``fa`2lx$e6~-Ud_I*ee^#}R hVc`@Yf,|@A4rDuD8*6cuPC>C[30 i) w=X`` Any questions pertaining to the license or use of the CPT must be addressed to the AMA. Reproduced with permission. var url = document.URL; The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement.
CMS Updates Medicare Discharge Codes. For discharges/transfers to state designated Assisted Living Facilities. 222 0 obj
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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). 0000048794 00000 n
Code 03 should not be used if the patient is admitted to a non-Medicare certified area. .gov %%EOF
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Discharged/transferred to a foster care facility with home care; and var pathArray = url.split( '/' ); ** The third digit classifies the type of care being billed.