Discharge Disposition Codes

PATIENT DISCHARGE STATUS CODES: NUBC FAQs

(As they appear in the NUBC Official UB-04 Data Specifications Manual 2008,

Version 2.00, July 2007)

Compiled by Sue Malone, MA, MBA, RHIA, FAHIMA

August 2007

[Editor Note: The editor takes no responsibility for the reasonableness or internal consistency of the

answers to these frequently asked questions. The purpose of this document is to permit coders to read

the actual text of the FAQs as compiled and presented by the NUBC.]

1 Q: A patient is discharged from our facility (disposition code 01) and is to go to a doctor’s appointment

the same day. The patient is then admitted to another hospital after seeing the doctor. What disposition code is

appropriate, 01 or 02?

A: Based on the information the hospital had at discharge, the patient was discharged to home (01). If your

facility was unaware of the planned admission at the second facility, it is likely that you will have to provide

support for your coding decision when the fiscal intermediary receives the claim for admission to another

hospital on the same day you discharged the patient.

2 Q: If a patient leaves before triage, or is triaged and leaves without being seen by the physician, what is

the appropriate discharge status? It does not seem right to use 07, left against medical advice, because no

“medical advice” was provided.

A: The full definition of 07 is “Left against medical advice or discontinued care.” Therefore, that is the

appropriate code to use when the patient discontinues care.

3 Q: What status code should be used for a patient transferred to a SNF rehabilitation unit? This unit is

within the SNF. Is this considered a transfer to a SNF or to a rehabilitation facility?

A: A rehabilitation unit that is part of a skilled nursing facility is paid under the SNF prospective payment system.

Moving a patient from one unit to another does not constitute a transfer for billing purposes and should not result

in separate claims. If a patient is discharged from an acute inpatient hospital to a SNF, use 03. Status code 03

is also used if the patient moves from an acute inpatient hospital to a rehab unit in a SNF.

4 Q: What code is used for patients discharged on home oxygen?

A: Use discharge status 01, discharged to home or self care.

5 Q: What code is used for patients discharged to partial hospitalization?

A: Use discharge status 01, discharged to home or self care.

6 Q: What code is used for patients discharged to home with follow-up visiting nurses?

A: If the patient is discharged to home with a written plan of care for home care services – whether home

attendant, nursing aides, certified attendants, etc. – use status code 06.

7 Q: What code is used for patients discharged to home with services by a DME supplier?

A: Use discharge status 01, discharged to home or self care.

8 Q: What code is used for patients discharged to court/law enforcement?

A: Use discharge status 01, discharged to home or self care.

9 Q: What code is used for patients discharged/transferred to residential care?

A: Use discharge status 01, discharged to home or self care.

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10 Q: What code is used for patients discharged/transferred to a foster care facility?

A: Use discharge status 01, discharged to home or self care.

11 Q: What code is used for patients discharged/transferred to a foster care facility with home care?

A: Use discharge status 06, discharged/transferred to home under the care of organized home health services

in anticipation of covered skilled care.

12 Q: What code is used for patients discharged to home under a home health agency with oxygen?

A: Use discharge status 06, discharged/transferred to home under care of organized home health services in

anticipation of covered skilled care. If the patient is discharged home with oxygen that is not provided through a

home health plan of care, use status code 01, discharged to home or self care.

13 Q: What code is used for patients discharged to home under a home health agency with DME?

A: Use status code 06, discharged/transferred to home under care of organized home health service

organization in anticipation of covered skilled care.

14 Q: How is a “long-term care hospital” (which the UB manual indicates should be coded to 63) different

from a SNF (often called a long-term care facility)? Should it be coded 03 or 04?

A: A long-term care facility (63) provides acute inpatient care with an average length of stay greater than 25

days. A skilled nursing facility certified by Medicare is coded with 03 and an intermediate care facility with 04. A

nursing facility that is not Medicare-certified is coded with 64.

15 Q: A facility may be licensed for multiple types of care. For example, a facility may hold licenses for both

skilled nursing and hospice. If it is not documented in the medical record as to which type of care a patient is

being discharged to, what code should be used?

A: Just like Medical Records follows up if there is no diagnosis, they should follow up on this, confirm where the

patient is being placed, and code accordingly.

16 Q: Code 04 is to be used for transfer to “state-designated assisted living facilities.” What is the

appropriate code if the patient is discharged/transferred to a skilled nursing component within an assisted living

facility?

A: If the discharge plan suggests an assisted living facility code with 04. Use 03 if the plan identifies a skilled

level of care in a Medicare-certified SNF.

17 Q: What discharge status code should be used in Form Locator 22 of the patient is going from an

inpatient hospital to an inpatient VA?

A: Use status code 43, discharged/transferred to a federal health care facility.

18 Q: Are the codes 50 (hospice/home) and 51 (hospice/facility) used by the hospital when the patient is

discharged from an inpatient bed or are they only to be used on hospice or home health type of bills?

A: Use 50 or 51 if the patient is discharged from an inpatient hospital to a hospice.

19 Q: What if a doctor indicated one thing but the discharge planner indicates another? What should be

coded?

A: Use common sense and use the best source to code. In this instance, probably the discharge planner will

have the most accurate and most current patient status.

20 Q: What code should be used by a home health agency when a patient has moved without notice and

the agency is unable to complete the plan of care?

A: Use status code 07, left against medical advice or discontinued care.

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21 Q: We are of the understanding that Patient Code 65 would become effective with the admissions of

April 1, 2004. Now our coding and abstracting vendor is telling us that they have been notified by CMS that this

implementation will not be effective until October 2004 or January 2005 with the implementation of the Medicare

Psychiatric Prospective Payment System. Can this code be used for payers other than Medicare? Our Medicaid

agency is asking us to use it.

A: Code 65 is appropriate for all payers.

22 Q: Can discharge status 30, Still Patient, be used on both inpatient and outpatient claims?

A: Yes, it can be used on both types of claims. Note, however, that Code 30 is primarily designed to be used on

inpatient claims when billing for leave of absence days or interim bills; 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).

23 Q: What discharge status code should be used when a patient is discharged/transferred to a SNF that is

both Medicare and Medicaid certified?

A: Use 03, discharged/transferred to skilled nursing facility (SNF) with Medicare certification in anticipation of

covered skilled care.

24 Q: What discharge status code should be used when a patient is discharged to a chemical dependency

treatment facility that is not part of a hospital?

A: If the chemical dependency treatment facility is not a psychiatric hospital or psychiatric distinct part unit of a

hospital, use Code 05, discharged/transferred to another type of institution not defined elsewhere in this code

list. (Note: The NUBC has approved the establishment of a new code (70) to take effect 10/1/07 for other

types of health care facilities not defined elsewhere in the code list.)

25 Q: What is the appropriate patient discharge status code for a patient transferred to a nursing facility for

a non-skilled/custodial/residential level of care? For example:

• The patient is discharged to a facility that is only certified with skilled beds but the patient does not

qualify for a skilled level of care.

• The Medicare certified nursing facility is licensed for both skilled and intermediate care beds, and the

patient is transferred to intermediate care.

• The patient resides at a Medicare certified SNF but only receives non-skilled services.

• The patient’s Medicare coverage for skilled nursing days has been exhausted for the year and patient

will only be receiving non-skilled care.

A: Use Code 04, discharged/transferred to an intermediate care facility (ICF).

26 Q: If a patient is discharged from acute hospital care but remains at the same hospital under hospice

care, what status code should be used for the acute stay discharge?

A: Use Code 51 Hospice – medical facility.

27 Q: What patient status code should be used for a patient transferred from an inpatient acute care

hospital to a Medicare-certified SNF under the following conditions?

a. 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.

b. Patient does not qualify for skilled level of care outside the hospice benefit for conditions

unrelated to the terminal illness.

A: For both conditions, use Code 51 Hospice – medical facility.

28 Q: If a facility discharges a patient to a personal care home, which is similar to assisted living facilities,

are they most appropriately coded as 01 or 04?

A: If the personal care home is the person’s place of residence, even temporarily, use Code 01, discharged to

home or self care.

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29 Q: If a patient is discharged from a hospital based Transitional Care Unit (i.e., skilled nursing unit) to the

acute hospital under Observation Status, what is the Discharge Status for the TCU claim?

A: Use Code 05, discharged/transferred to another type of institution not defined elsewhere in this code list.

30 Q: What discharge status code should be used when a patient is sent to another acute care facility for

an outpatient procedure later in the day? This occurs when we do not have the equipment to perform the

procedure and the intention is that the patient will not be returning to our facility after the procedure.

A: Since this is a discharge to outpatient treatment, and it is expected that the patient will go home afterward,

use discharge status 01, discharged to home or self care.

31 Q: If a patient is discharged from an acute care hospital to a Medicare-certified swing bed in a SNF, is

the discharge status of 03 correct, or should it be 61?

A: SNFs do not have Medicare-certified swing beds. Use 03 if the patient is discharged/transferred to skilled

nursing facility (SNF) with Medicare certification in anticipation of covered skilled care. Use Code 61 for

reporting patients discharged/transferred to a SNF level of care within the hospital’s approved swing bed

arrangement.

32 Q: Per FAQ #17 on the NUBC website, “What discharge status code should be used in Form Locator 17

if the patient is going from an inpatient hospital to an inpatient VA… Use status code 43.” If the VA has a psych

unit, would it still be 43 and not 65?

A: If the patient is transferred to a VA hospital or to a psych unit within a VA hospital, Code 43,

discharged/transferred to a federal health care facility, should be used.

33 Q: We have a Home Health Agency with DME, often we find the orders read, “Home with Walker”. We

do not see a physician order for home health care nor has there been an assessment documented by the

receiving home health nurse. The nursing discharges instructions check “home”. Is the Patient Status Code still

06?

A: No. “Home with Walker” does not imply a discharge to home under care of organized home health service

organization in anticipation of covered skilled care. Accordingly, Code 01, discharged to home or self care

(routine discharge) would be appropriate.

34 Q: Various issues/questions regarding the use of Code 08, discharged/transferred to home under care

of a Home IV provider:

• We are having a problem coding patients who go home with IVs. If we code home with IV, Medicare

states it should be home healthcare only. We need something we can identify to know when to use

home with IV.

• If IV services are provided under a home health agency which patient status code is assigned? The

status code of 08 is confusing when they refer to a “Home IV provider.”

• A point of confusion at our facilities. A patient is discharged from the hospital with a PICC line for Home

IV therapy. Is this Home Health 06 or IV Infusion 08?

• How would you abstract disposition for patients who go home with a PICC line and an Infusion company

is coming in for PICC line care only? No drugs are administered to the patient. Would the disposition be

01 – Home, 06 – Home Health, or 08 – Home on IV drug therapy?

A: Code 06 is to be used only when a patient is discharged/transferred to home under care of organized home

health service organization in anticipation of covered skilled care. Although Code 08 might be appropriate for

the situations described above, it is used infreguently, redundant to Code 01 and causes confusion. Accordingly,

Code 08 was DISCONTINUED effective October 1, 2005 at which time the appropriate patient status code for

these types of situations is simply Code 01, discharged to home.

35 Q: If a patient is discharged from an acute care hospital and PT/OT is arranged to be done in the home

by a rehabilitation agency that is not affiliated with the home health care agency that made the arrangements,

what is the appropriate code to use – 01 or 06?

A: If the therapy services are being provided under the home health benefit (e.g., Medicare Part A), use Code

06; if the therapy is provided under the outpatient therapy benefit (e.g., Medicare Part B), use Code 01.

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36 Q: What is the difference between residential care and assisted living care?

A: In terms of patient status codes, there is no difference. Discharges to residential care and private (non-state

designated/supported) assisted living facilities are coded alike (01).

37 Q: A patient in a swing bed at a Critical Access Hospital is discharged back to the acute part of the CAH.

What patient status code do we use?

A: Use Code 66, Discharged/transferred to a Critical Access Hospital (CAH).

38 Q: A patient is discharged from an acute care hospital to a CAH swing bed. What patient status code

do we use?

A: Use Code 61, Discharged/transferred to hospital-based Medicare approved swing bed. Swing beds are not

part of the post acute care transfer policy.

39 Q: What are the general guidelines that hospitals should use to determine the proper patient status

code to use when discharging someone to hospice?

A: The level of care that will be provided by the hospice upon discharge is essential to determining the proper

code to use.

Hospice Levels of Care

1. Routine or Continuous Home Care. Patient 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.

2. General inpatient care. Patient 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.

3. Inpatient respite. Patient 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 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).

40 Q: An established non-skilled nursing home patient (i.e., the nursing home is their permanent residence)

is transferred to an acute setting. Upon discharge, they are sent back to the same nursing home from which

they came to a designated hospice unit/bed. What patient status code would be appropriate?

A: Use Code 50, Hospice – Home if the person is going back to that bed as a routine or continuous home care

hospice patient. If the patient is going back to a skilled level of care (even though it is the same bed/facility) use

Code 03.

41 Q: An established nursing home patient (i.e., the nursing home is their permanent residence) is

transferred to an acute setting. Upon discharge, they are sent back to the same nursing home with a hospice

referral only. What patient status code would be appropriate?

A: If the patient has not made a hospice election, and has a referral only, use Code 01, Discharged to Home.

42 Q: A 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. What patient status

code would be appropriate?

A: Use Code 51, Hospice – Medical Facility.

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43 Q: A patient is admitted from home (a private residence) to an acute setting. Upon discharge, the

patient is transferred as a new nursing home placement with hospice referral only. What patient status code

would be appropriate?

A: If no hospice election has been made, and the nursing facility is non-skilled, the appropriate code would be

04; if the transfer is to a Medicare certified SNF in anticipation of covered skilled care, the appropriate code

would be 03.

44 Q: A patient was discharged to home with home health services. Two days later the patient was

readmitted to our hospital. We were notified by the discharge planner of the patient’s readmission and the fact

that home health services were not started for the patient and the discharge status code needed to be changed

to 01. By the time of the discharge planner’s notification, we had already submitted the patient’s bill with the

discharge status code of 06. In this instance what should the correct discharge status code be on this patient?

A: To ensure accurate reimbursement and reporting, send a replacement claim with the correct discharge

status code (01).

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