Medicaid Discharge Codes

A patient discharge status code is a two-digit code that identifies where th

e 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).

A patient discharge status code is a two-digit code that identifies where th

e 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 patient discharge status codes listed below is not an all-inclusive list.

Patient Discharge Status Code (FFS) This variable is contained in the follow

ing files: Home Health Agency (Fee-for-Service), Hospice (Fee-for-Service), Inpatient (Fee-for-Service), Outpatient (Fee-for-Service), Skilled Nursing Facility (Fee-for-Service)

The discharge status code identifies where the patient is being discharged t

o 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 patient’s medical record supports the billed discharge status code.

A0310F Entry/Discharge Code Back to top This variable is contained in the fo

llowing files: Long Term Care Minimum Data Set (MDS) - Swing-Bed 3.0 , Long Term Care Minimum Data Set (MDS) 3.0

The 2020 ICD-10-CM files below contain information on the ICD-10-CM updates

for FY 2020. These 2020 ICD-10-CM codes are to be used for discharges occurring from October 1, 2019 through September 30, 2020 and for patient encounters occurring from October 1, 2019 through September 30, 2020.

405.9 Admission/discharge. (a) General. (1) The governing body shall establi

sh and implement written admission and discharge policies to protect the health and safety of the patients and shall not assign or delegate the functions of admission and discharge to any referral agency and shall not permit the splitting or sharing of fees between a referring agency and the hospital.

A patient discharge status code is a two-digit code entered into Form Locato

r (FL) 17 on the UB-04 claim form that identifies the patient's status 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 found in FL 6 on the UB-04).

As a government program, Medicaid claims must follow specific medical coding

processes in order to bill for procedures. Medicaid’s purpose is to assist low-income people pay for part or all of their medical bills. Medicaid, like Medicare, was created by the 1965 Social Security Act. It is federally governed but locally administered. Medicaid falls into […]

Provide updated guidance to readmission reduction teams for updating dischar

ge processes, based on Centers for Medicare & Medicaid Services (CMS) documents. Description This tool, adapted from the CMS Conditions of Participation (COPs), provides a checklist of discharge elements that CMS states should be provided to all Medicare and Medicaid ...

CPT Code Description 99217 Observation care discharge day management (This c

ode is to be utilized to report all services provided to a patient on discharge from outpatient hospital "observation status" if the discharge is on other than the initial date of "observation status." To report services to a patient designated as "observation status" or "inpatient status" and discharged on the same ...

Code Description; 06: End Stage Renal Disease (ESRD) patient in the first 30

months of entitlement covered by employer group health insurance. Medicare may be a secondary insurer if the patient is also covered by an employer group health insurance during the patient's first 30 months of ESRD entitlement.

The procedure code list below includes NP, PA and CNM taxonomies that now ca

n be billed through NCTracks. Codes currently in process for system updates will be added to this list, in red, once system modifications are completed. Newly identified codes will be addressed as they are received by the NC Medicaid Clinical section.

However, Medicare prohibits billing a discharge day management service on th

e same day that a required E/M visit is furnished under the CPT TCM codes for the same patient. Thus, you cannot count ...

Code 04: Discharged / transferred to an intermediate care facility is the co

de for nursing homes not certified by Medicare or Medicaid or for state-designated assisted living facilities. Code 05: As of April 1, 2008, this is the code for discharged / transferred to designated cancer centres or children’s hospitals.

MTL 3336-20-02: Medicaid payment rule and Clinical Lab rule COVID-19 Emergen

cy rule provisions; MTL 3336-20-01: Clarification of services provided by a substitute practitioner; MTL 3336-19-04: Amendment of Ohio Administrative Code Rule 5160-1-60, Medicaid payment; MTL 3336-19-03: Chemotherapy

Inaccurate hospital discharge coding may have introduced bias in studies rel

ying on these codes (eg, evaluations of Medicare bundled payment models). Inaccuracy was more common among Medicaid-enrolled patients and safety-net and low-volume hospitals, suggesting more potential bias in existing study findings pertaining to these patients and ...

Discharge Destination Code Changes (PRO Review Code - C) DG: Diagnosis Relat

ed Grouper (DRG) Change and Day Outlier Denial (PRO Review Code - G) DH: DRG Change and Cost Outlier Denial (PRO Review Code - H) DI: DRG and Beneficiary Liability Change (PRO Review Code - I) DO: Day Outlier Denial - No Payment (PRO Review Code - D) DP

UB 04 Medicare Discharge status code,01 Discharged to home or self-care (rou

tine discharge) 02 Discharged/transferred to another short-term general hospital 03 Discharged/transferred to SNF. CMS 1500 claim form and UB 04 form- Instruction and Guide Instructions and guideline for CMS 1500 claim form and UB 04 form. ...

Scheduled date of Admission (this code may only be used on an outpatient cla

im) 41: Date of First Test for Pre-admission Testing (this code may be used only if date of admission was scheduled prior to administration of test(s)) 42: Hospice discharge due to patient revocation: 43: Scheduled date of Cancelled Surgery: 44

If a code “C3” or “C4” is in FL 24-30, indicating that the QIO has d

enied all or a portion of this billing period, the provider shows the number of days determined by the QIO to be covered while arrangements are made for the patient’s post discharge.

The Hospice file contains claims submitted by Medicare hospice providers. Re

cords are included in the file regardless of whether the beneficiary is enrolled in fee-for-service (FFS) Medicare or Medicare Advantage (Medicare managed care.) This file is based on information from the CMS form 1450 (UB04).

Please refer to the Centers for Medicare and Medicaid Services (CMS) Claims

Processing Manual, Publication 100-04, Chapter 3, Sections 20.7.4 (acute care hospital), 140 (IRF, Inpatient Rehabilitation Facilities), 190 (LTCH, Long Term Care Hospitals).

Plan of Care Completed - as of 10/1/1995 Replaces code 50. MEDICAID OUTPATIE

NT ONLY (Not a valid NUBC code) 91: Pre-Admission - as of 10/1/1995 Replaces code 51. ... The table below is the conversion mapping of the DDA Disposition Code and UBF Discharge Status to the New York State Patient Status or Disposition Code. Where both DDA and UBF were ...

1. A claim is billed with patient discharge status codes 01 (patient dischar

ged to home or self-care); however the beneficiary was transferred to another facility. An adjustment needs to be submitted to correct patient status code.

NC Medicaid (Division of Health Benefits) is dedicated to providing access t

o physical and behavioral health care and services to improve the health and well-being of over 2.1 million North Carolinians on behalf of the North Carolina Department of Health and Human Services.

Hospice Medicare Billing Codes Sheet. Hospice Medicare Billing Codes Sheet.

LICENSES AND NOTICES. License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition ... Condition Code (FL 18-28) H2: Discharge for cause (i.e. patient/staff safety) CMS Pub. 100-04, Chapter 11, Section 30.3: Top.

CMS Updates Medicare Discharge Codes. 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.. These codes are important in understanding the discharge status as reported to CMS by the hospital and may impact post-acute Medicare ...

Medicare pays for different kinds of DME in different ways. Depending on the

type of equipment: You may need to rent the equipment. You may need to buy the equipment. You may be able to choose whether to rent or buy the equipment. Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers ...