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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.

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