National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

MMR-2007 12A, December 2007

New Patient Status Discharge Code 70 to Define Discharges or Transfers to Other Types of Health Care Institutions not Defined Elsewhere in the UB-04 (CMS-1450) Manual Code List

Provider Types Affected
Providers submitting claims to Medicare contractors (fiscal intermediaries (FI), and Part A/B Medicare Administrative Contractors (A/B MAC)) for services provided to Medicare beneficiaries

Provider Action Needed

Impact to You
This article is based on Change Request (CR) 5764, which provides implementing instructions for a new patient discharge status code 70 and a definition change to existing patient discharge status code 05.

What You Need to Know
New patient discharge status code 70 was created in order for providers to be able to indicate discharges/transfers to another type of health care institution not defined elsewhere in the code list. This code is effective for use by providers for discharge dates on or after April 1, 2008, and patient discharge status code 05 has been redefined to indicate a discharge/transfer to a designated cancer center or children’s hospital.

What You Need to Do
See the Background and Additional Information sections of this article for further details regarding these changes.

Background
The UB-04 claim form includes the Patient Status Code as Field Locator 17. The Patient Status Code is a two-digit code to indicate the disposition or discharge status of the beneficiary on a submitted claim, and it is a required field on all institutional claims. Several members of the NUBC participated in a workgroup to ensure the clarity of the definitions of patient discharge status codes, and as a result of the NUBC workgroup meeting, the following patient discharge status code changes are being implemented by NUBC effective April 1, 2008:

• New patient discharge status code 70 was created in order for providers to be able to indicate discharges/transfers to another type of health care institution not defined elsewhere in the code list. This code is effective for use by providers for discharges/to dates on or after April 1, 2008.

• Patient discharge status code 05 has been redefined, effective April 1, 2008, to indicate a discharge/transfer to a designated cancer center or children’s hospital.

Note: For Inpatient Prospective Payment System (IPPS) hospitals, the post-acute transfer payment policy will not apply to claims that contain patient discharge status code 70.

CR5764 also revises the Medicare Claims Processing Manual, Chapter 1, Section 50.2.1 (Inpatient Billing from Hospitals and SNFs), to reflect these patient status code changes and these revisions can be found in the attachment to CR5764.

Additional Information
The official instruction, CR5764, issued to your FI and A/B MAC regarding this change may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R1361CP.pdf on the Centers for Medicare & Medicaid Services (CMS) Web site.

If you have any questions, please contact your Medicare FI or A/B MAC at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS Web site.

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.