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 Part A coverage in the skilled nursing facility and home care. In addition, CMS has added a specific code for discharges related to disaster situations.

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).  

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 addition, CMS emphasizes that proper discharge coding is just as critical a factor in ensuring proper claims filing and processing as any other coding and providers are responsible for ensuring accurate discharge designations.

Among the new codes CMS has added are:

NEW PATIENT DISCHARGE STATUS CODE

NEW READMISSION PATIENT DISCHARGE STATUS CODES

83	Discharged/Transferred to a Skilled Nursing Facility (SNF) with Medicare Certification with a Planned Acute Care Hospital Inpatient Readmission
86	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)

Please be sure to reference SE0801 and SE1411 for more details.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827