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What is the CPT Code for Nursing Home Discharge?

In the United States, discharge to residential care and nursing homes are coded as 01. Code 01 involves discharge to home; jail or law enforcement; home on oxygen if DME only; any other DME only; group home, foster care, and other residential care arrangements; outpatient programs, such as partial hospitalization or outpatient chemical dependency programs; nursing homes that are not state – designated.

In the United States, the discharge disposition code is a two – digit code that identifies where the patient is at the conclusion of a healthcare facility encounter or at the end time of a billing cycle.

It belongs in Form Locator 17 on a UB-04 claim form or its electronic equivalent in the HIPAA compliant 837 format. Have it in mind that billing the incorrect code may affect the patient’s payment, and will also impact any other facility receiving the patient, often preventing them from successfully submitting their claim to Medicare.

Uses and Benefits of a Discharge Disposition Code

For instance, the discharging facility uses Discharge Disposition 01 (discharged home to care for himself/herself (also considered a routine discharge); however, the submitted documentation indicated the patient was discharged to a rehabilitation facility and should have used Discharge Disposition 62.

This wrong coding will entail incorrect payment to the discharging hospital and the admitting facility may not get paid due to the incorrect billing of the discharge facility.

Agreeably, plans can change after the patient is discharged resulting in the patient going to a different location than what was expected or documented in the medical record. That is why nursing homes are always advised to follow – up with the patient after discharge and prior to submitting the claim to Medicare to ensure the patient went to the planned facility that was recorded in the medical record.

A little follow-up will prevent incorrect billing of the Discharge Status Code and avoid unnecessary adjustments to claims when the incorrect code is used. Improper payments due to incorrect billing of Discharge Status Codes are also costly to the Medicare program and are easily preventable.

Aside from being guilty of having sent a “false claim to the government”, or being at risk for compliance penalties and claim recoupment, Medicare expects to receive a corrected claim before it will return the provider’s money, so the hospital must also factor in delayed repayment with the other penalties.

Healthcare facilities in the United States are expected to have a finely honed process involving care management, coding, and billing to make sure the initial claim goes out correctly, gets paid correctly, and stays paid correctly. Here is the most common discharge disposition codes used for discharging inpatients to ensure the systems operate smoothly:

30 Common Discharge Disposition Codes for Nursing Homes

  1. Code 0: Unknown Value (but present in data)
  2. Code 01: Code to use for a patient who is discharged home to care for himself / herself (also considered a routine discharge).
  3. Code 02: Discharged / transferred to a short – term general hospital, which usually means acute regular hospital to acute regular hospital (not long – term acute care).
  4. Code 03: Discharged / transferred to a skilled nursing facility with Medicare certification in anticipation of skilled care. This refers to serious skilled care rather than custodial care alone. The code does not change because the patient runs out of benefit days. It is not to be used if the patient is admitted to a non – Medicare – certified area. If the hospital gives the patient an approved swing bed, then the code is 61.
  5. Code 04: Discharged / transferred to an intermediate care facility is the code for nursing homes not certified by Medicare or Medicaid or for state-designated nursing homes.
  6. Code 05: As of April 1, 2008, this is the code for discharged / transferred to designated cancer centres or children’s hospitals. Non-designated cancer centres are code 02. (The designated list is available at / cancer centers / centerslist.html.)
  7. Code 06: Discharged / transferred to home under care of organized home health service organization in anticipation of covered skilled care. If the patient goes home with a written plan of care from a home health agency or for home care services (not simply a cook or a maid), use this discharge status code. 06 are also appropriate for a discharge to foster care with home care. Do not use it for home health services provided by a durable medical equipment supplier or a home IV provider.
  8. Code 07: Left against medical advice or discontinued care. Keep in mind that this also applies to patients who move or are unreachable to complete a home health agency plan of care.
  9. Code 08: This patient discharge status code is reserved for national assignment.
  10. Code 09: Admitted as an Inpatient to this Hospital. This code is for use only on Medicare outpatient claims, and it applies only to those Medicare outpatient services that begin greater than three days prior to an admission.
  11. Code 10-19: Reserved for National Assignment. These patient discharge status codes are reserved for national assignment.
  12. Code 20: Expired. This code is used only when the patient dies.
  13. Code 21-29: Reserved for National Assignment. These patient discharge status codes are reserved for national assignment.
  14. Code 30: Still Patient or Expected to Return for Outpatient Services.
  15. Code 40: Expired at home (hospice claims only)
  16. Code 41: Expired in a medical facility such as hospital, SNF, ICF, or freestanding hospice. (Hospice claims only)
  17. Code 42: Expired – place unknown (Hospice claims only)
  18. Code 43: Discharged / Transferred to a Federal Hospital. This code applies to discharges and transfers to a government operated healthcare
  19. Code 44-49: Reserved for National Assignment
  20. Code 50 and 51: Discharged / Transferred to a Hospice. These two patient discharge status codes are used to identify when a patient is discharged or transferred to hospice care.
  21. Code 52-60: Reserved for National Assignment
  22. Code 61: Discharged / Transferred to a Hospital-based Medicare Approved Swing Bed. This code is used for reporting patients discharged / transferred to a SNF level of care within the hospital’s approved swing bed arrangement. When a patient is discharged from an acute hospital to a Critical Access Hospital (CAH) swing bed, use Patient discharge status Code 61. Swing beds are not part of the post acute care transfer policy
  23. Code 62: Discharged / Transferred to an Inpatient Rehabilitation Facility Including Distinct Part Units of a Hospital. Inpatient rehabilitation facilities (or designated units) are those facilities that meet a Specific requirement that 75 percent of their patients require intensive rehabilitative services for the treatment of certain medical conditions.
  24. Code 63: Discharged / Transferred to Long Term Care Hospitals
  25. Code 64: Discharged / Transferred to a Nursing Facility Certified under Medicaid but not Certified under Medicare.
  26. Code 65: Discharged / Transferred to a Psychiatric Hospital or Psychiatric Distinct Part Unit of a Hospital.
  27. Code 66: Discharged / Transferred to a Critical Access Hospital (CAH)
  28. Code 67-69: Reserved for National Assignment
  29. Code 70: Discharged / transferred to another Type of Health Care Institution not Defined Elsewhere in this Code List.
  30. Code 71-99: Reserved for National Assignment

It is important to select the correct patient discharge status code, and in cases in which two or more patient discharge status codes apply, you should code the highest level of care known. Omitting a code or submitting a claim with an incorrect code is a claim billing error and could result in an Nursing Home claim being rejected or the claim being cancelled and payment being taken back.