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Issue 2006-05, May 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Source Admission Code “D”
Provider Types Affected
Providers billing Medicare fiscal intermediaries (FIs) for claims involving inpatient transfers within the same facility.
Impact on Providers
Impact to You
This article is based on information from Change Request (CR) 3881 in which the Centers for Medicare & Medicaid Services (CMS) reported that it requested and received a new Source of Admission Code “D.”
What You Need to Know
The new Source Admission Code “D” is needed to specifically identify a source of admission from the same facility. This is especially important to inpatient psychiatric facilities (IPFs). The IPF Prospective Payment System (PPS) has an emergency department adjustment, but that adjustment is not applicable when the patient is transferred from acute care to an IPF unit in the same hospital and the Admission Code “D” will identify this situation.
What You Need to Do
See the Background section of this article for further details regarding this change.
Background
This article is based on information from Change Request (CR) 3881 which informs Medicare providers that CMS requested and received a new Source of Admission Code from the National Uniform Billing Committee (NUBC) to define transfers from hospital inpatients in the same facility resulting in a separate claim to the payers.
The Source of Admission Code is a required code for Medicare, and it indicates the source of this admission. CR3881 instructs this new Source of Admission Code to be used wherever it might apply, including transfers involving:
- Distinct part units in an acute care hospital (ACH);
- A unit in a critical access hospital (CAH); or
- A swing bed located in an ACH.
This new Source Admission Code will have some specific consequences for inpatient psychiatric facilities (IPF). For instance, if an IPF has a dedicated emergency department, then the IPF Prospective Payment System (PPS) has a payment adjustment to the first day of an inpatient psychiatric stay. This is a facility-level adjustment, not a patient-level adjustment.
The payment adjustment is not to be applied if the patient is transferred from the acute area to the IPF in the same hospital because the costs for the emergency department are already considered in the DRG payment to the acute hospital.
CMS is currently basing decisions on a Source of Admission Code “4” (CMS originally thought the policy applied for any transfer from acute), and Code “4” is too broad for this scenario. As a result, CMS will use Source of Admission Code “D” to determine a transfer within a facility.
The following table describes Source of Admission Codes “4” and “D”:
| Source of Admission Code |
Descriptor |
“4” |
Transfer From a Hospital (Different Facility)
Inpatient: The patient was admitted to this facility as a hospital transfer from a different acute care facility where he/she was an inpatient.
Outpatient: The patient was referred to this facility for outpatient or referenced diagnostic services by (a physician of) a different acute care facility. |
“D” |
Transfer From Hospital Inpatient in the same facility resulting in a separate claim to the payer. |
Summary
In summary, CR3881 provides the following specific instructions for providers and their intermediaries:
- Medicare contractors will accept new Source of Admission Code “D” as a valid Source of Admission Code.
- IPF PPS providers should review all claims submitted with Source of Admission Code “4.”
- IPFs should adjust claims submitted with Source of Admission Code “4” that should be coded with the new Source of Admission Code “D.” Payment will remain the same.
- IPFs should resubmit their claims coded correctly with Source of Admission Code “4” that were paid incorrectly (i.e., not given the emergency room adjustment when facility has an emergency department).
Implementation
The implementation date for CR3881 is April 3, 2006.
Additional Information
The official instruction issued to your FI, CR3881, may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R718CP.pdf  on the CMS Web site.
If you have questions, please contact your Medicare intermediary at their toll-free number which may be found at http://www.cms.hhs.gov/apps/contacts/  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.
MLN Matters Number: MM3881
Pub. 100-4, Transmittal# R718CP, CR# 3881
Related CR Release Date: October 21, 2005
Effective Date: April 1, 2006
Implementation Date: April 3, 2006
Additional Information Provided by Empire Medicare Services
* The adjustment should include a Source of Admission Code “D,” a claim change reason code of D9, and remarks to indicate the IPF is correcting the Source of Admission Code per CR 3881.
** IPFs should adjust such claims, not resubmit such claims. Resubmitted claims will be rejected as duplicate claims. The adjustment should include a Source of Admission Code “4” (no change from original claim), a claim change reason code of D9, and remarks to indicate the IPF is correcting the Source of Admission Code per CR 3881.
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