December 28, 2000
Medi -889-00
TO: ALL MEDICARE PROVIDERS
SUBJECT: REVISED PATIENT STATUS CODES
PRIMARY INTERESTS: BUSINESS OFFICE MANAGERS
EFFECTIVE DATE: APRIL 1, 2001
The Health Care Financing Administration has announced the following revisions to the codes available in Form Locator 22 on the HCFA 1450/UB92 claim form.
Form Locator 22, Patient Status is revised to modify the structure of four existing codes and to add three new codes to enable you to more accurately code a patients’ status. These changes are primarily necessary because of the exclusion of transfers to swing beds from §4407 of Public Law 105-33 which created new rules for discharges from PPS hospitals to postacute care providers. The words "for inpatient care" were added to Code 02. Reference to the new swing bed code 61 was added to Code 03. Reference to outpatient care was removed from Code 05. The words "or expected to return for outpatient services" was removed from Code 30. A new Code 61 was added for discharges/transfers within this institution to a hospital based Medicare approved swing bed. Codes 71 and 72 were added for discharges/transfers/referrals to another (Code 71) or this (Code 72) institution for outpatient services.
Code Structure
01 Discharged to home or self care (routine discharge)
02 Discharged/transferred to another short-term general hospital
for inpatient care03 Discharged/transferred to SNF
(For hospitals with an approved swing bed arrangement, use Code 61-Swing Bed. For reporting discharges/transfers to a non-certified SNF, use Code 04-ICF.)04 Discharged/transferred to an Intermediate Care Facility (ICF)
05 Discharged/transferred to another type of institution (including distinct parts)
06 Discharged/transferred to home under care of organized home health service organization
07 Left against medical advice or discontinued care
*09 Admitted as an inpatient to this hospital
20 Expired (or did not recover - Christian Science Patient)
40 Expired at home (Hospice claims only)
41 Expired in a medical facility, such as a hospital, SNF, ICF or freestanding hospice (Hospice claims only)
42 Expired - place unknown (Hospice claims only)
50 Hospice - home
51 Hospice - medical facility
61 Discharged/transferred within this institution to a hospital-based Medicare approved swing bed
71 Discharged/transferred/referred to another institution for outpatient services as specified by the discharge plan of care
72 Discharged/transferred/referred to this institution for outpatient services as specified by the discharge plan of care
*In situations where a patient is admitted before midnight of the third day following the day of an outpatient diagnostic service or service related to the reason for the admission, the outpatient services are considered inpatient. Therefore, code 09 would apply only to services that began longer than 3 days earlier or were unrelated to the reason for admission, such as observation following outpatient surgery, which results in admission.
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