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License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

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. 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. Applications are available at the AMA websiteExternal Website.

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. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

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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. 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. 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. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. 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. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

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The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. 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. 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.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright © 2002, 2004 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

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November 23, 2016 - Revised March 18, 2021

Patient Discharge Status Codes and Hospital Transfer Policies

Patient discharge status codes identify where a patient is at the conclusion of a health care facility encounter or at the end of a billing cycle. You are responsible for coding the discharge bill based on the discharge plan for the patient, and if you later learn that the patient received post-acute care, the hospital should submit an adjustment bill to correct the discharge status code following Medicare’s claim adjustment criteria located in the CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 1External PDF, Section 130.1.1 and Chapter 34External PDF

Patient discharge status codes are part of the Official UB-04 Data Specifications Manual and are used nationwide by institutional, private, and public providers, and payers of health care claims. The National Uniform Billing Committee (NUBC) develops and maintains the data elements and codes. To assist in the proper coding of a patient discharge status code, you may access data elements, codes, and FAQs by referring to the UB-04 Data Specifications Manual on the National Uniform Billing CommitteeExternal Website website. (Note: your organization may need to subscribe.)

Reporting incorrect patient discharge status codes may result in the following:

  • Claim denials and recoupment of payment due to a post-payment review decision
  • Claim rejections due to edits in the Fiscal Intermediary Shared System (FISS) to prevent incorrect payments
  • Inquiries to the Provider Contact Center (PCC) as a result of a claim denial or rejection to obtain the correct patient discharge status (e.g., In some cases, the patient’s status may change after leaving your facility.)

CMS published the following Special Edition MLN Matters articles to provide clarifications and instructions on determining the correct patient discharge status code to use when completing your claims:

  • SE21001External PDF, “Review of Hospital Compliance with Medicare’s Transfer Policy with the Resumption of Home Health Services & Other Information on Patient Discharge Status Codes”

Discharge Definition

For the purpose of discussing transfers the following terms describe when a patient leaves the hospital. The definitions of discharges and transfers under the inpatient prospective payment system (IPPS) are in 42 CFR 412.4(a) and (b)External Website.

A discharge occurs when a Medicare patient:

  1. Leaves a Medicare IPPS acute care hospital after receiving complete acute care treatment or
  2. Dies in the hospital

An acute care transfer occurs when a Medicare patient in an IPPS hospital (with any MSDRG) is:

  1. Transferred to another acute care IPPS hospital or unit for related care (Patient Discharge Status Code 02 or Planned Acute Care Hospital Inpatient Readmission Patient Status Code 82)
  2. Admitted to another PPS on the same day after leaving their designated IPPS hospital against medical advice (Patient Discharge Status Code 07)
  3. Transferred to a hospital that would ordinarily be paid under the IPPS, but is excluded because of participation in a state or area wide cost control program (Patient Discharge Status Code 02 or Planned Acute Care Hospital Inpatient Readmission Patient Status Code 82)
  4. Transferred to a hospital or hospital unit that hasn’t been officially determined as being excluded from IPPS such as:
    1. An acute care hospital that would otherwise be eligible to be paid under the IPPS, but doesn’t 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)
    2. A Critical Access Hospital (Patient Discharge Status Code 66 or Planned Acute Care Hospital Inpatient Readmission Patient Status Code 94)
  5. Discharged but then readmitted the same day to another IPPS hospital (unless the readmission is unrelated to the initial discharge). This may occur when a hospital discharges the patient to home (Patient Discharge Status Code 01), the patient goes to a doctor’s appointment the same day and is then admitted to another hospital. If the first hospital was unaware of the planned admission at the second hospital, it’s 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.

References:

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